Development of a Dance/Movement Therapy-Influenced Seated Ballroom Dance Program for Adult Day Services for Persons with Dementia" (2018)

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12-14-2018 The aM nzano Movement Method (M3): Development of a Dance/Movement Therapy- Influenced Seated Ballroom Dance Program for Adult Day Services for Persons with Dementia Joshua Reese "Zano" Manzano Columbia College Chicago

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Recommended Citation Manzano, Joshua Reese "Zano", "The aM nzano Movement Method (M3): Development of a Dance/Movement Therapy-Influenced Seated Ballroom Dance Program for Adult Day Services for Persons with Dementia" (2018). Creative Arts Therapies Theses. 112. https://digitalcommons.colum.edu/theses_dmt/112

This Thesis is brought to you for free and open access by the Thesis & Capstone Collection at Digital Commons @ Columbia College Chicago. It has been accepted for inclusion in Creative Arts Therapies Theses by an authorized administrator of Digital Commons @ Columbia College Chicago. For more information, please contact [email protected]. THE MANZANO MOVEMENT METHOD (M3): DEVELOPMENT OF A DANCE/MOVEMENT THERAPY-INFLUENCED SEATED BALLROOM DANCE PROGRAM FOR ADULT DAY SERVICES FOR PERSONS WITH DEMENTIA

Joshua Reese “Zano” Manzano

Thesis submitted to the faculty of Columbia College Chicago

in partial fulfillment of the requirements for

Master of Arts

Dance/Movement Therapy & Counseling

Department of Creative Arts Therapies

December 14, 2018

Committee:

Susan Imus, MA, BC-DMT, LCPC, GL-CMA Chair, Creative Arts Therapies

Laura Downey, EdD, BC-DMT, LPC, GL-CMA Research Coordinator

Laura Allen, MA, BC-DMT, LCPC, GL-CMA Thesis Advisor

Mariah LeFeber, MA, BC-DMT, LPC Reader

In dedication to my great-grandmother,

Juanita Gatioan Alop (September 3, 1925 – September 30, 2018).

Your memory lives on through the Manzano Movement Method (M3). Thank you for inspiring me to pursue work in the field of dementia.

Remember, we usually can’t choose the music life plays for us, but we can choose how we dance to it. Make yours a beautiful memory.

Unknown

i Abstract

The purpose of this thesis was to develop a dance/movement therapy (DMT)-influenced seated ballroom dance program for adult day services for persons with dementia. This program development project, named the Manzano Movement Method (M3), aims to support quality of life by encouraging creative expression, reminiscence and socialization. M3 explored how seated ballroom dance can support the quality of life for this population via six different lessons of the following dances: waltz, cha cha, rumba, tango, foxtrot and swing. It also explored how the program can be utilized by care providers that are not dance/movement therapists. With collaborator help—stakeholders at an adult day program for persons with dementia, including dance/movement therapists and a non-DMT care provider—the Delphi Method was implemented through an initial questionnaire, an informal interview and a final questionnaire. Information was categorized using a theory approach logic model to outline the resources/inputs, program activities, outputs and outcomes. Development of the program was guided by Tom Kitwood’s

(1997) person-centered care, and after integrating his approach with the synthesized product of the collaborator’s input, a consensus was made to creating the final project. Cross-cultural and ethical factors were considered in the creation of the program. The program includes a written curriculum, PowerPoint presentations of each lesson and a supplementary video that provides movement examples. In conclusion, the direction of M3 will be determined by future plans for implementation in various settings or populations, further research and expansion of the program and evaluation from greater institutions.

ii Acknowledgements

I would first like to thank my collaborators. Without them I could not have completed this project. The following are, in alphabetical order by last name: Dani Owens, Grace Pelzer,

Stephanie Terrell, and Elizabeth Williams. Thank you to Laura Downey, the research coordinator, who understood my vision and ensured me that I was on the right path. Special thanks to my advisor, Laura Allen, for supporting me through every step of the process. Her support was unwavering. A huge thanks goes to Mariah LeFeber for taking the time and effort to edit my thesis. Your guidance, patience and expertise in the field are much appreciated.

I would also like to thank my video team. Thank you to Nessa de Leon for filming, editing and participating in my video. Thank you to Emily Higgins for participating as a collaborative dancer in the video; fun times! Thank you to my wonderful editor, Victoria Griffin, for continuously reading and editing my work so that it gets published at its full potential. Also, a special thanks goes to Dee McCord of I Do Dance Studio for donating the space for the development of the video program.

Finally, I could not have done this without the help of my friends and family. Always thankful to my mom, Lorna Manzano, and my grandma, Rose Manzano. You all have been there for me from the very beginning and have helped me emotionally, mentally, physically, financially and spiritually. I owe you my deepest gratitude.

iii TABLE OF CONTENTS

CHAPTER 1: INTRODUCTION ...... 1 QUESTIONS FOR EXPLORATION ...... 2 Primary ...... 2 Secondary ...... 2 PURPOSE ...... 2 MOTIVATION FOR THE PROJECT ...... 2 THEORIES AND TECHNIQUES OF A CLINICAL APPROACH ...... 3 DEVELOPMENT OF THE MANZANO MOVEMENT METHOD (M3) ...... 6 Value of M3 ...... 7 CONTRIBUTION TO THE FIELD ...... 8 Contribution to Dance/Movement Therapy ...... 9 CHAPTER 2: LITERATURE REVIEW ...... 11 DEMENTIA ...... 12 Alzheimer’s Disease ...... 15 Best Practice Dementia Care ...... 16 DANCE/MOVEMENT THERAPY ...... 17 Dance/Movement Therapy with Older Adults ...... 18 Laban Movement Analysis and Bartenieff Fundamentals ...... 20 Integration of Ballroom Dance as a Form of Dance/Movement Therapy ...... 21 CONCLUSION ...... 24 CHAPTER 3: METHODS ...... 26 COLLABORATORS ...... 26 Recruitment Procedure ...... 26 Setting ...... 27 INFORMATION GATHERING ...... 27 Round 1 ...... 28 Round 2 ...... 28 Round 3 ...... 29 APPROACH ...... 29 Resources/Inputs ...... 30 Program Activities ...... 30 Outputs ...... 31 Outcomes ...... 32 INFORMATION ANALYSIS ...... 32 PRESENTATION ...... 32 CHAPTER 4: MANZANO MOVEMENT METHOD (M3) ...... 33 LESSON 1: WALTZ ...... 33 LESSON 2: LATIN DANCE ...... 36 Lesson 2a: Cha Cha ...... 36 Lesson 2b: Rumba ...... 39 LESSON 3: TANGO ...... 42 LESSON 4: BIG BAND BALLROOM ...... 46

iv Lesson 4a: Foxtrot ...... 46 Lesson 4b: Swing ...... 49 CHAPTER 5: DISCUSSION ...... 52 IMPLEMENTATION ...... 52 Challenges for Implementation ...... 52 CROSS-CULTURAL CONSIDERATIONS ...... 54 ETHICAL CONSIDERATIONS ...... 56 DANCE/MOVEMENT THERAPY VS. DMT-INFLUENCED PROGRAM ...... 57 FUTURE PLANS AND EVALUATION SUGGESTIONS ...... 58 CONCLUSION ...... 60 REFERENCES ...... 62 APPENDICES ...... 67 APPENDIX A: DEFINITION OF KEY TERMS ...... 68 APPENDIX B: CHACE AND KITWOOD INTEGRATION MODEL ...... 71 APPENDIX C: COLLABORATOR AGREEMENT ...... 72 APPENDIX D: LOGIC MODEL ...... 73 APPENDIX E: ROUND 1 QUESTIONNAIRE ...... 74 APPENDIX F: ROUND 3 QUESTIONNAIRE ...... 76 APPENDIX G: VIDEO AGREEMENT ...... 77 APPENDIX H: POWERPOINT PRESENTATIONS ...... 78 APPENDIX I: DANCE/MOVEMENT THERAPY VS. THERAPEUTIC DANCE MODEL ...... 79 APPENDIX J: MOOD SCALE ...... 80 VIDEO ...... 81

v Chapter One: Introduction

With 5.7 million Americans living with Alzheimer’s disease, a number that is projected to increase to nearly fourteen million by 2050 (Alzheimer’s Association, 2018b), dementia care and proper therapeutic programming are needed more than ever. Creative arts therapies such as dance/movement therapy (DMT) can be seen as an effective means to dementia care. “Every 65 seconds, someone in the United States develops the disease…[and] 1 in 3 seniors dies with

Alzheimer’s or another dementia,” (Alzheimer’s Association, 2018b, para. 1). With the relevance of this illness, professionals can provide support and therapeutic programming to lessen the development of Alzheimer’s and increase the lifespan with more fulfillment for people affected by the disease. Ballroom dance, specifically, has many benefits and can be utilized to supplement healthcare in the lives of people with dementia. This program development project examined how ballroom dance can be utilized for older adults with dementia, and explored the significance ballroom dance has to aid this population.

According to the American Psychological Association (2013), neurocognitive disorder is the formal clinical name for dementia. This will be explained further in the literature review chapter. For the purpose of this thesis, dementia and Alzheimer’s disease will be used interchangeably; however, Alzheimer’s/Alzheimer’s disease are used to express the most common type of dementia in which this thesis is premised.

The following terms will surface throughout this thesis: ballroom dance, creative expression, dance/movement therapy-influenced or DMT-influenced dance program, dementia, person-centered dementia care or person-centered care, quality of life, reminiscence, seated format and socialization. Please refer to Appendix A for definitions.

Questions for Exploration

Primary. How can seated ballroom dance in a dance/movement therapy-influenced dance program be utilized to support the quality of life of older adults with dementia?

Secondary. How can this program be utilized by care providers who are not dance/movement therapists?

Purpose

The purpose of this thesis was to develop a dance/movement therapy-influenced dance program for adult day programs for persons with dementia—called the Manzano Movement

Method (M3)—which provides a seated format ballroom dance program that can be facilitated without a dance partner and can be facilitated by a non-dance/movement therapy care provider. It was created to support the quality of life of persons with dementia by supporting creative expression, reminiscence and socialization, as they are key elements to this program development project.

Motivation for the Project

Dance/movement therapists have the tools to integrate their dance skills and experiences into how they creatively facilitate DMT. Because my background is in ballroom dancing, I wanted to explore how I can apply this knowledge as therapy, other than what I understood ballroom dancing to be—performance, choreography, and competition. My experience in ballroom dancing extends to working with individuals of all ages, couples, dance teams, paid work and volunteer service. Because of the vast amount of experience I have working in the field of ballroom dance, I was able to see how this style of dance helped people become more confident, strengthen their relationships, and find a deeper understanding of themselves in

2 relation to others, both physically and mentally. As I began to reach the end of the

Dance/Movement Therapy & Counseling program, I aimed to solidify my own experiences and apply them in a way that may be therapeutic and beneficial to others, especially in the growing need for dementia-related services. My curiosity about ballroom dancing as part of DMT treatment has been growing ever since I began my graduate studies.

Interest in this practice stems from the integration of my personal and professional life.

My great-grandmother had Alzheimer’s disease, which motivated me to pursue the work to better understand and support her. She became the “1 in 3 seniors [to die] with Alzheimer’s

[disease]” (Alzheimer’s Association, 2018b, para. 1). This heartbreak, and the fact that this disease is so prevalent, made it clear to me how important it is to create a program that can enhance the quality of life these individuals are enduring. Thus, ideas for M3, a ballroom dance program aimed for my great-grandmother, and anyone else in her situation, was formed. I knew she would have loved and benefited from a program like this, and my hope is that it will support current care as well as enhance the quality of life of others with dementia.

Theories and Techniques of a Clinical Approach

Person-centered care is a philosophy and approach regarding dementia care by Thomas

Kitwood, in which the person comes first, not the disease (1997). The premise of person- centered care is that people with dementia are people like everyone else—people with needs, wants, and desires. It is up to the family, caregivers, and clinicians to adapt to any changes in the individual, to support the best quality of life they can, and to see that those needs, wants, and desires are satisfied as fully as possible. Person-centered care compels the clinician to see the person with dementia as a person first. That is, “[the care provider] should see a PERSON with dementia, not a person with DEMENTIA,” (North Shore Senior Center, 2014, p. 8). Person-

3 centered care maintains and upholds the value, dignity, and respect of the person (Kitwood,

1997). It honors the individual, despite the level of cognitive impairment. Person-centered care sees so-called problem behaviors as attempts at communication, letting the care provider know what is needed or what is wrong as opportunities for communication with the person. This approach believes all behavior has meaning, and all action is meaningful (Kitwood, 1997). It attempts to provide for the needs of the person. Person-centered care then incorporates the following to become positive person work: recognition, negotiation, collaboration, play, timalation or sensory stimulation, celebration, relaxation, validation, holding a safe psychological space, facilitation, creating and giving; which provides the approach and way of facilitating person-centered care (Kitwood, 1997).

Clinicians can utilize person-centered care, which is based on the following counseling psychology techniques. The first step is to create a safe “environment that has focus, and can contain and hold the human being; a coherent, rather than a fragmented space…that invites the person to emerge, to express, [and] to communicate,” (Chaiklin & Wengrower, 2016, p. 223).

From here it is important to create the therapeutic relationship. According to Kitwood, a relationship such as an I-thou relationship is vital as it pertains to an equal relationship—imagine a relationship in which the therapist is walking beside the client; seeing them as equally human and in need of care. An I-it relationship rather, would diminish the value of the person (Chaiklin

& Wengrower, 2016), which would shy away from person-centered care altogether. This relationship can be imagined as one where the therapist does not view their client as being a whole person; just a diminished version of who they once were. This existential-humanistic framework moves the individual towards positive and possible human relations on a multicultural level to which people are seen as people rather than objects (Ivey, D’Andrea, &

4 Bradford Ivey, 2012). As opposed to seeing a dementia patient, clinicians then acknowledge and respect each person for who they are—their race/ethnicity, religion, culture, etc., and integrate these factors into providing person-centered care.

Along with viewing people with dementia as people first, clinicians who adhere to this philosophy should also incorporate socialization experiences in their practice. This includes nurturing the self and building relationships with others. For example, by building a trusting relationship, clinicians can then begin to build upon the socialization experience (Chaiklin &

Wengrower, 2016). Bringing the attention to the self, nurturing the self, and promoting well- being is the primary concern, then the focus can extend to building on the participant’s relationships with others. Clinicians can use introductions and goodbyes as great ways to acknowledge the self. Nurturing can be done through body/self-awareness by “promoting [the] feeling of one’s self through movement, touching, and being touched,” (Chaiklin & Wengrower,

2016, p. 223-224). This can be accompanied by vocalizing the client’s presence. Nurturing the self can also be seen by affirming and validating the client in every way possible. This is where the concept of symbolism by DMT pioneer, Marian Chace, is utilized. This symbolism is the process of which the clinician guides the clients to create visual meaning out of their movements when a personal memory and sharing of movement and words may surface (Chaiklin &

Wengrower, 2016).

Finally, when caring for people with dementia, particularly in a group setting, interventions through Chace’s concept of group rhythmic activity are vital. Because memory loss affects overall mood including self-image and self-esteem, ritualized group movements can be used to express some of the basic emotions such as anger, happiness and even sadness, to create

5 social bonding. This, in turn, may foster an atmosphere in which the clients can regain a sense of self-worth and vitality.

Development of the Manzano Movement Method (M3)

Development of this method began when I first discovered my interest in DMT. I have always been curious as to how I can combine my passion and expertise in ballroom dancing with the practice of DMT to create my own type of ballroom dance therapy. As I journeyed through my master’s program, and came to terms with the heartbreak of seeing my great-grandmother struggle with Alzheimer’s disease, I realized not only did I want to combine ballroom with

DMT, but I also wanted to work with older adults in their fight with the disease; especially since my motivation for ballroom dancing came from that generation—that of my great-grandparents.

I figured since they loved it so much, and that it was so therapeutic for them, that it would be a great way to integrate my ballroom knowledge with that type of population.

Thus, I chose an internship at an adult day program for persons with dementia. It was the perfect situation in which I could combine DMT and ballroom dance programming for older adults. The internship gave me the opportunity to work in a clinical setting with older adults with different types of dementia—especially those with Alzheimer’s disease. Being there gave me the experience and knowledge to learn first-hand the needs of this population and how to apply and integrate DMT with ballroom dance.

The adult day program offered a variety of movement-based groups, including DMT, seated exercise/stretching and strength training. Besides DMT, a dance/movement therapist would sometimes facilitate the exercise/stretching and strength training groups. At times, the

DMT groups being facilitated would be inspired by the flamenco, belly dancing, and even yoga.

Otherwise, music from the participants’ era would be played and creative movement would be

6 facilitated. Being a ballroom dancer, I realized the music being played for the participants did not coincide with the movements that would generally be done in a dance setting. For example, the song playing would be danced in the style of foxtrot, rumba, waltz, or swing, but the movements associated with that style of music would not necessarily be used by the facilitators. It was at that moment that I began to form the ideas for M3. I began to explore how I might integrate the music and the coinciding ballroom dance movements to create a DMT-influenced ballroom dance program; which could promote and support creative expression, socialization, and reminiscence.

As a dance/movement therapist in training, it was important to learn how to observe and analyze movement, and to learn how to apply it into creating movement-based interventions in a clinical setting. This is where Bartenieff Fundamentals and Laban Movement Analysis (LMA) came into play, which will be discussed more in the next chapter (Moore, 2014). My experience of LMA informed me about the participants’ behaviors and safety concerns without specifically communicating verbally. LMA also guided how I could integrate specific fundamental movement patterns and qualities with ballroom dance movements, which shaped how I envisioned the movements in the dance lessons to model a DMT framework.

Each day at internship I was able to trial some ideas that I had for my program. These trials were made with the hopes that the program could be used at other dementia-related sites, gerontology facilities, and other clinical settings. This program started with one lesson comprising of a dance like the waltz, and ended with multiple lessons that included the foxtrot, tango, cha cha, rumba, and swing.

Value of M3. Older adults with dementia are faced with challenges that affect cognitive functioning (Sabbagh & Cummings, 2011). Person-centered care can be viewed as a holistic approach in order to support the quality of life of people with dementia. Education, lifestyle,

7 attitude, and mental and physical well-being are some key factors within the realm of cognitive functioning (North Shore Senior Center, 2014). According to Silva Lima & Pedreira Vieira

(2007), ballroom dancing can target these key factors through learning the movements, discovering the life of the dance, having a feel for the nature of the dance, and creating expressive movement of each style. Thus, participants in dementia care settings can benefit from a DMT-influenced ballroom dance program.

Contribution to the Field

This program development project is aimed to expand on the programming and care available to older adults. This project is intended to enhance the overall experience this generation will have in various settings, and intended to contribute to the various aspects of care these individuals need; especially in a clinical setting. Older adults will have the opportunity to explore reminiscence with the music and movement from their adolescent, young adult, and adult years. Music such as that from the 1940s all the way to the 1970s are the perfect age range of music applied in this program. Being able to be immersed in such music aims to facilitate reminiscence. Even movements or dance moves from an individual’s past can be recalled when seeing and doing familiar dance moves, paired with the music, by a facilitator.

This program development project is intended to enhance the current body of knowledge and literature for best practice, care, programming, and research of gerontology. This program development project is intended to aid any ballroom dance programs that are currently being used in various settings. What made this program development project novel was the nature of the safety factor this program encompassed. It is a seated ballroom dance program, which provided a safety feature to the ambulatory structure of ballroom dancing. This is especially unique and important for providing this type of programming for older adults with dementia

8 since physical traits such as mobility and ambulation may begin to deteriorate. Since this program was created to have the capabilities of being facilitated by a non-dance/movement therapist, it intended to further contribute to the field of gerontology as dance instructors, care providers, family members, and other personnel can provide dance in the safest way by being seated, rather than standing with or without a partner.

Contribution to dance/movement therapy. This program is intended to enhance the current body of literature and aims to develop on the current DMT-influenced dance programs that have been previously applied through the approaches and culture of ballroom dance. This program development project provides a platform of DMT-influenced ballroom dance practices that can be studied, replicated, and improved upon by other dance/movement therapists in the future. This program development project offers ballroom-integrated DMT interventions, which can provide the participants with a body-mind connection experience by using ballroom dance movements individually or with others in a group. It is important to note that this program can be effective whether facilitated by a dance/movement therapist or a non-dance/movement therapist care provider. A dance/movement therapist facilitating the program can use their skills and knowledge to provide DMT interventions that may interface with ballroom dance movements. A non-DMT care provider can still facilitate the program and key-in on movement directives related to ballroom dancing and the supplementary material provided, which can still be effective therapeutically.

The creation of this program aimed to expand beyond the amount of dance/movement therapists working with people with dementia and the type of programming they can facilitate.

With the high and growing numbers of people with Alzheimer’s disease, as mentioned earlier in the statistics from the Alzheimer’s Association (2018b), it was important to address the limited

9 availability for dance/movement therapists to facilitate such a program for which this population can relate to. It was also important to recognize the value of using a DMT framework to create an accessible program that can be facilitated by dance/movement therapists and non-DMT care providers already working in the field. This DMT-influenced ballroom dance program project can contribute to the growing body of research and application in similar populations and environments, and serve as a therapeutic activity that person-centered professionals can utilize.

10 Chapter Two: Literature Review

This literature review focuses on the use of ballroom dance as a form of DMT with older adults with dementia, primarily Alzheimer’s disease. It explores how the literature describes levels of dementia, dementia care, current DMT practices with older adults with dementia, and how ballroom dance can be utilized as a therapeutic practice to support the quality of life of the population.

According to the American Psychological Association (2013), dementia is an old term for the diagnosis of major neurocognitive disorder (NCD), which is currently used per the

Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-5). However, the term dementia is still used widely by physicians and other clinicians for older adults as NCD is often preferred for conditions affecting younger individuals (American Psychological

Association, 2013, p. 591). For this thesis, the term dementia will be used to indicate the NCD of an older adult with substantial decline in at least one of the six domains: complex attention, executive function, learning and memory, language, perceptual-motor and social cognition

(American Psychological Association, 2013).

Because it is the most common etiology, Alzheimer’s disease is the primary focus of dementia in this thesis. According to the Alzheimer’s Association (2018b), statistics show that more than five million Americans are living with Alzheimer’s disease. It is the sixth leading cause of death in the United States, killing more people than breast cancer and prostate cancer combined (Alzheimer’s Association, 2018b). Finally, studies show that one in three older adults dies from Alzheimer’s or some other dementia (Alzheimer’s Association, 2018b).

11 Dementia

Dementia lives on a spectrum of mild to major neurocognitive disorder in terms of cognitive and functional impairment with the key feature of cognitive decline (American

Psychological Association, 2013). To determine the severity of the dementia, six cognitive domains are taken into account.

The first domain is complex attention which includes sustained attention or maintaining attention over time, divided attention or performing two different tasks within the same period of time, selective attention or maintaining attention while in competition with other stimuli/distractions, and processing speed (American Psychological Association, 2013). The following are examples of symptoms or observations related to complex attention according to the American Psychological Association (2013):

Has increased difficulty in environment with multiple stimuli (TV, radio, conversation);

is easily distracted by competing events in the environment. Is unable to attend unless

input is restricted and simplified. Has difficulty holding new information in mind, such as

recalling phone numbers or addresses just given, or reporting what was just said. Is

unable to perform mental calculations. All thinking takes longer than usual, and

components to be processed must be simplified to one or a few (p. 593).

The second domain is executive function which includes planning, decision making, working memory or the ability to briefly hold and manipulate the information presented, feedback/error utilization or the ability to utilize information in order to solve a problem, overriding habits/inhibition or ability to process a more complex correct solution, and mental/cognitive flexibility or the ability to navigate between two concepts (American

Psychological Association, 2013). The following are examples of symptoms or observations

12 related to executive function according to the American Psychological Association (2013):

“Abandons complex projects. Needs to focus on one task at a time. Needs to rely on others to plan instrumental activities of daily living or make decisions,” (p. 593).

The third domain is learning and memory which includes immediate memory or the ability to repeat information concurrently, recent memory or encoding new information, and other types of memory (American Psychological Association, 2013). These other memory facets include free recall such as words or elements of a story, cued recall such as items on a list, recognition memory or the ability to recognize something from immediate memory, semantic memory such as facts, autobiographical memory of personal events or related persons, and implicit learning of the unconscious (American Psychological Association, 2013). The following are examples of symptoms or observations related to learning and memory according to the

American Psychological Association (2013): “Repeats self in conversation, often within the same conversation. Cannot keep track of short list of items when shopping or of plans for the day. Requires frequent reminders to orient to task at hand,” (p. 594).

The fourth domain is language which includes expressive language or identifying things, grammar and syntax, and receptive language or comprehension (American Psychological

Association, 2013). The following are examples of symptoms or observations related to language according to the American Psychological Association (2013):

Has significant difficulties with expressive or receptive language. Often uses general-use

phrases such as ‘that thing’ and ‘you know what I mean,’ and prefers general pronouns

rather than names. With severe impairment, may not even recall names of closer friends

and family. Idiosyncratic word usage, grammatical errors, and spontaneity of output and

13 economy of utterances occur. Stereotypy of speech occurs; echolalia and automatic

speech typically precede mutism (p. 594).

The fifth domain is perceptual-motor which includes visual perception, visuoconstructional or hand-eye coordination, praxis or the ability to imitate gestures, and gnosis or recognition of faces and colors (American Psychological Association, 2013). The following are examples of symptoms or observations related to perceptual-motor according to the

American Psychological Association (2013): “Has difficulties with previously familiar activities

(using tools, driving motor vehicle), navigating in familiar environments; is often more confused at dusk, when shadows and lowering levels of light change perceptions,” (p. 595).

The sixth domain is social cognition which includes recognition of emotions, and theory of mind or the ability to identify another’s emotional/mental state (American Psychological

Association, 2013). The following are examples of symptoms or observations related to social cognition according to the American Psychological Association (2013):

Behavior [is] clearly out of acceptable social range; shows insensitivity to social

standards of modesty in dress or of political, religious, or sexual topics of conversation.

Focuses excessively on a topic despite group’s disinterest or direct feedback. Behavioral

intention without regard to family or friends. Makes decisions without regard to safety

(e.g., inappropriate clothing for weather or social setting). Typically, has little insight into

these changes (p. 595).

Impairments in these six domains are key features of dementia. They make up the complexity of the disorder and are used to understand the different characteristics of an individual with dementia. In order to provide proper therapy, one must be knowledgeable of the disorder and the nuances each individual may present. Complex attention, executive function,

14 learning and memory, language, perceptual-motor and social cognition are separate facets of dementia, and will look different with each diagnosis according to severity and other biopsychosocial-cultural factors. Each of these domains are looked at discretely in order to provide proper therapy according to best practice.

Alzheimer’s disease. The DSM-5 states that Alzheimer’s has an onset among individuals between the ages of 65-85, and it is the most common etiology of dementia as it comprises eighty percent of individuals with major neurocognitive disorder (American Psychological

Association, 2013). According to Sabbagh & Cummings (2011), Alzheimer’s disease is a disorder with the gradual progression of significant cognitive, functional, and behavioral dysfunction, and the decline is inevitable even with therapy and treatment. As the disease progresses into the more advanced stages, symptoms worsen and become more critical to treat

(Sabbagh & Cummings, 2011).

A diagnostic feature of Alzheimer’s disease is sundowning or late-day confusion. This term refers to a state of confusion that occurs during the late afternoon to nighttime and can yield a number of behaviors, including confusion, anxiety, aggression, insubordination, pacing and wandering (Graff-Radford, 2017). The following are factors that may cause or worsen sundowning: fatigue, dim lighting, inconsistent circadian rhythm, discerning reality, and urinary tract infection (Graff-Radford, 2017).

A diagnosis of the disorder depends on many factors that include, but are not limited to: blood tests, mental status evaluations and brain scans; however, the diagnosis will still be specified as either possible or probable depending on an individual’s biopsychosocial-cultural background. If there is no positive genetic evidence, the Alzheimer’s disease is possible; whereas it will be specified as probable if Alzheimer’s disease runs in the family (Morrison, 2014).

15 Although Alzheimer’s disease is only one etiology of dementia, it is one that is widely known in today’s society. There is a vast body of literature regarding Alzheimer’s as it is a common disorder amongst older adults.

Best practice dementia care. As mentioned previously, best practices for dementia care can incorporate person-centered care. It is a philosophy and approach in which the person comes first. The premise of person-centered care is that people with dementia are people like everyone else that have feelings, needs to be met and wants and desires (Fazio, Pace, Maslow,

Zimmerman, & Kallmyer, 2018). It is up to the family, caregivers, and clinicians to adapt to any changes in an individual to support their quality of life, and to see that those needs, wants and desires are satisfied as fully as possible. It is the clinician’s responsibility to see the person with dementia as a person first. Person-centered care honors the individual despite the level of cognitive impairment. Person-centered care allows both the client and clinician to better understand and communicate with each other. It explores every behavior in order to support and provide adequate care to the client. Through this approach, positive person work provides the essential necessities of quality of life.

The first step in person-centered care is to create a safe environment that can contain and hold the person with dementia in a coherent space that invites the person to emerge, express and communicate (Chaiklin & Wengrower, 2016). From here, an existential-humanistic framework then moves the individual toward positive and possible human relations on a multicultural level in which people are seen as people rather than objects, similar to that of an I-thou relationship that is explained by Kitwood (Ivey, D’Andrea, & Bradford Ivey, 2012). Building a trusting relationship will build upon an individual’s social experience with the clinician and with others

(Chaiklin & Wengrower, 2016). Person-centered care, along with an existential-humanistic

16 framework, can work in tandem to support the quality of life of older adults with dementia. It is essential to apply these theories and practices for the clinician to provide appropriate programming, especially when it supports the overall mental and physical states of the participants.

Dance/Movement Therapy

According to the American Dance Therapy Association (2016), DMT is “the psychotherapeutic use of movement to promote emotional, social, cognitive and physical integration of the individual,” (para. 1). Dance/movement therapy focuses on an individual’s movement behavior, which includes expression, communication, and adaptation. It is practiced in a variety of clinical, educational, and private settings to treat a gamut of social, physical, and psychological challenges in both individuals and groups of people of all cultures and backgrounds (American Dance Therapy Association, 2016).

At the forefront of DMT practices, when working with older adults with dementia is the theoretical framework of Marian Chace, the original pioneer of DMT (Levy, 2005). Chace was instrumental to the foundation of how professionals use DMT today. As a dancer and a clinician, she experimented with integrating her dance background and clinical knowledge/experience to providing DMT for her patients. Since then, her legacy, theory, and methodology live on in modern DMT. According to Levy (2005), the four core concepts of Chace’s work are body action, symbolism, therapeutic movement relationship, and group rhythmic movement relationship. Body action provides expression of emotion through utilizing movement of the body and different body parts (Levy, 2005). Symbolism uses imagery and fantasy via visualization and other forms of creative expression in order to bring forth recollection and enactment (Levy, 2005). Therapeutic movement relationship utilizes mirroring, a technique of

17 reflective movement, to understand and validate the person being seen (Levy, 2005). Group rhythmic movement relationship organizes the expression into communal movements and brings thoughts and feelings into a shared rhythm (Levy, 2005). Chace’s theory can be applied to working with older adults with dementia, according to best practice.

Dance/movement therapy with older adults. Joan Erenberg integrated Chace’s core concepts with Kitwood’s person-centered approach, explicating that these theories and concepts can be utilized harmoniously into effective dementia care. In her thesis, Erenberg (2007, p. 9) explained that “person-centered care and the healing arts therapies share the objectives of preservation and maximization of the dementia client’s sense of self,” which bringing the attention to and nurturing the self is a DMT technique. Erenberg linked Chace’s concepts of body action, symbolism, therapeutic movement relationship, and group rhythmic relationship (Levy,

2005) with Kitwood’s twelve interactions of recognition, negotiation, collaboration, play, timalation, celebration, relaxation, validation, holding, facilitation, creation and giving (Kitwood,

1998) (see Appendix B). Chace and Kitwood have parallel languages that speak to both DMT and dementia care by utilizing non-verbal kinesthetic attunement to build empathy with people with dementia (Erenberg, 2007). The DMT work of Chace and the dementia care expertise of

Kitwood share “the belief that the felt experience surpasses the need for language and can provide a more direct connection with a person with cognitive impairment,” (Erenberg, 2007, p.

14). Therefore, the application of DMT is highly effective in best practice dementia care.

As mentioned earlier, bringing attention to the self, nurturing the self, and promoting well-being through body/self-awareness is a DMT technique professionals use by being with the self through movement, touching, and being touched (Chaiklin & Wengrower, 2016). Nurturing the self can also be seen through affirmation and validation. Because memory loss affects overall

18 mood, ritualized group movements can be used to express some of the basic emotions such as anger, disgust, fear, happiness, sadness, and surprise, which creates social bonding. This, in turn, may foster an atmosphere in which the person with dementia can regain the feeling of self-worth and revitalization (American Dance Therapy Association, 2015).

In the book Waiting at the Gate by Sandel & Johnson (1987), movement therapy stimulated reminiscence with older adults by providing the opportunity for it in a purposeful manner within the context of a social setting. The action of the movement was the medium for interaction in and of itself, and fostered the opportunity for expression of feelings and the capacity of socialization (Sandel & Johnson, 1987). This in a group setting that holds a safe and open space was maintained, and in some cases improved an individual’s social functioning when engaging with consistent time, place and social interactions (Sandel & Johnson, 1987). These factors contributed to the creation of a safe and familiar environment.

In the article by Kate Jackson (2014), expressive therapy was found to be effective when used to treat older adults with Alzheimer’s disease and other related etiologies of dementia.

Jackson (2014) explained that Alzheimer’s disease, “in which emotion and memory are stirred in the absence of conscious thought, is at the core of how expressive therapists are helping [these] individuals…through various artistic modes,” (p. 10). According to Jackson (2014), modalities such as DMT were found to be most effective for people with dementia because cognitive impairments are no barrier for an individual’s participation. This is to say that sensory deficits influence an art form, which is difficult to make sense of, and therefore symbolism and imagery were most helpful via a medium such as DMT. The article expressed that DMT provided an outlet for the individual to express and communicate nonverbally. Most importantly, the article explained that previous knowledge of dance or having full body mobility is not needed for DMT

19 as breathing is the most fundamental movement, and if the individual can breathe, then they can engage in DMT (Jackson, 2014). Dance/movement therapy in this context shows how useful it is in maximizing one’s quality of life and shows how effective it can be with treating older adults with dementia. This article bolstered the significance of a DMT framework for M3.

Dance/movement therapy can be applied with the lens of a person-centered framework to support quality of life for older adults with dementia. According to Hill (2016), DMT can provide the platform to understand, attune to and care for these individuals and their families.

Hill’s literature (2016) focused on the strength DMT has on yielding empathy, sensitivity, expression and community around people with dementia. According to Hornthal (2012), dancing, specifically DMT, has strength and value when utilizing it to care for people with aphasia, cognitive impairment and dementia in general. Hornthal’s literature bridged the overall importance of DMT and what a dance/movement therapist can do to facilitate therapy with the older adult population in terms of utilizing alternative forms of nonverbal communication.

Laban Movement Analysis and Bartenieff Fundamentals. Dance/movement therapists utilize Bartenieff Fundamentals with Laban Movement Analysis (LMA) as a tool to observe, notate and analyze movement to inform clinicians of the client’s process and state-of-being in order to provide appropriate movement-based and body-based interventions (Chaiklin &

Wengrower, 2016). The use of LMA can provide the clinician with the opportunity to be with the client somatically and use nonverbal cues and communication throughout a session. Laban

Movement Analysis is a valuable tool for dance/movement therapists to use as it focuses on the fact that “[m]ovement is a process of change [and]…[h]uman movement is intentional,” (Moore,

2014, p. 23). That is, all movement has meaning, and people move in certain ways for a reason.

20 The four main categories of LMA are body, effort, space, and shape (Moore, 2014). The body category focuses on what parts of the body are mobile and stable. It also focuses on the phrasing and sequence of movement as well as different body connectivities, including breath

(Hackney, 2002). The effort category focuses on how the movement is being made; it focuses on the quality of movement. Effort focuses on direct and indirect use of space, strong and light use of weight, quick and slow use of time, and bound and free flow of movement (Moore, 2014). The space category focuses on where the movements are being made around the body, and where the body itself is moving in space. It focuses on different planes and dimensions for which the body can move within (Moore, 2014). Finally, the shape category focuses on modes of shape change and shape qualities. Modes of shape change explores the shape of the movement in different pathways through space. Shape qualities explore the motions of movement and “the process of changing the shape and placement of the body in space,” (Moore, 2014, p. 123).

The four categories of LMA were used to explore different movement patterns and directives that could be used to create the ballroom dance movement interventions. In the video

(see page 76), movement examples were inspired by different body connections and sequences, quick and slow use of time, direct and indirect use of space and a variety of shape modes and qualities, etc. (Moore, 2014). These qualities of movement can expand on an individual’s movement repertoire, which could support the creative expression piece of M3.

Integration of ballroom dance as a form of dance/movement therapy. Research articles and theses on various ballroom dance styles, a spectrum of disorders and ages of populations, and different aspects of well-being are included in this section of the literature review.

21 In the thesis by Brooke Miller (2018), a qualitative case study was done on the experience of couples in which one partner had dementia. Dance/movement therapy was facilitated using ballroom dance as the method for intervention. This study explored the changes of relationship throughout the course of a five-week ballroom dance-based DMT group. From the study, the participants experienced an elevation in mood, physical improvements, and were able to “spend quality time together, participate in an enjoyable activity, and meet the core needs of people with dementia,” (Miller, 2018, p. 53).

The study also proved that the strength of the participants’ relationship was key, and that these relationships were also guided by reminiscence (Miller, 2018). There was a high amount of reminiscence that arose from each participant’s experience such as how they fell in love, a previous dance experience, or their first dance with their spouse. Dance, in and of itself, was another theme that arose as the act of dancing brought pure enjoyment and companionship among the participants (Miller, 2018). This study provided validity to the highly effective impact ballroom dance in a DMT setting has on people with dementia. It used Kitwood’s person- centered care approach as well as positive person work. Ballroom dancing, combined with

Kitwood’s approach, are the foundation of M3.

Grace Pelzer (2018) did a similar program development project. Her thesis was based on ballroom dance as intervention for caregivers and patients who received cancer treatment at a private hospital. Pelzer’s project (2018) also utilized a theory approach logic model for categorizing input from collaborators, which included the Delphi method. However, besides the difference in population between the programs, M3 is intended to enact a program, while Pelzer’s project (2018) is intended to create a model for a program.

22 More specifically, Pelzer’s ballroom dance program (2018) explored how this form of dance could impact the biopsychosocial needs of people diagnosed with cancer and the well- being of them and their caregivers. This included factors such as “mood disturbances, depression, anxiety, intimacy concerns [and] isolation,” (Pelzer, 2018, p. i). The program curriculum consists of the waltz, swing, foxtrot, tango, rumba, and merengue (Pelzer, 2018); five of which are the same dances used in M3. Although the intentions and lessons are different from

M3, the curriculum uses a similar Chacian structure of a warm-up, activity and closing/discussion; and explores creative movements in the body for the self and with others.

Pelzer’s thesis provided this project with the literature support of integrating ballroom dance with DMT in a clinical setting.

In the article by Kiepe, Stockigt, & Keil (2012), various studies were summarized to explain how DMT and the integration of ballroom dance were shown to have an effect on adults with breast cancer, dementia, Parkinson’s disease, heart failure, type two diabetes, depression, and fibromyalgia. According to the results, positive changes in quality of life, body image, balance and coordination occurred when ballroom dance in a DMT session was facilitated

(Kiepe, Stockigt, & Keil, 2012). Different ballroom dance styles such as the waltz, Argentine tango, rumba, swing, and foxtrot yielded positive effects related to the aforementioned disorders and symptoms by maximizing quality of life and effectively supporting people with physical and mental illnesses.

According to Polo (2010), different aspects of relationship experienced by engaging in the art of the Argentine tango can be observed and assessed through DMT interventions. There was a deeper understanding of various types of relationship connections such as: self, other, and the relationship itself, to which the movements and character within the Argentine tango invited

23 another layer of relationship (Polo, 2010). This type of ballroom dance is beneficial in DMT as it provides a relational aspect using social-based interventions. While M3 does not include the

Argentine style of tango, the relationship connections of one style of ballroom dance would be pertinent to any style of ballroom dancing such as those in M3.

According to Silva Lima and Pedreira Vieira (2007), mental, physical and psychological well-being of older adults were increased when administered various ballroom dance classes such as swing, bolero, foxtrot, waltz, salsa, samba and tango. There was a profound social aspect of dancing these styles as evidenced by the participants’ responses such as: entertaining, playful, relaxing, happiness, good thoughts, youthfulness, reconnection to culture, love and sharing good moments (Silva Lima & Pedreira Vieira, 2007). According to Silva Lima & Pedreira Vieira

(2007), self-care became the focus of strength that these ballroom dances had on older adults. In essence, the ballroom dance styles mentioned above had been shown to be beneficial with the populations presented, and if utilized with person-centered care in a DMT approach, can be highly effective to the overall wellness of older adults. This is why M3 curriculum utilizes these approaches.

Conclusion

Upon reviewing the literature, it can be concluded that one way to properly care for people with dementia is by utilizing body-based interventions in the form of ballroom dance; which is beneficial to supporting the quality of life of older adults with dementia. Alzheimer’s disease is the most common of the dementia etiologies and is incurable; therefore, it is pertinent that individuals of this population receive proper care to slow down the inevitable progression of dysfunction in all of the six cognitive domains: complex attention, executive functioning,

24 learning and memory, language, perceptual-motor, and social cognition (American Psychological

Association, 2013).

Person-centered care is also a humanistic treatment for older adults with dementia and should be considered. Because people with dementia are affected mentally, physically, and emotionally, DMT practices utilizing LMA are effective for programming. Socialization must also be addressed and to do so with the different levels of community, communication, and compassion, ballroom dance in DMT can be used, which will provide a holistic therapeutic approach and complete wellness.

This literature review surfaced a multitude of questions. While this thesis addressed the use of ballroom dance as DMT for persons with dementia, further research is needed to delve deeper into these questions: What types of ballroom dances are best used to support the quality of life of older adults with dementia? How can these styles of dance specifically be beneficial to provide therapy for individuals with dementia? Can ballroom dance be an effective technique of

DMT if engaged by oneself or with others?

25 Chapter Three: Methods

The purpose of this thesis was to develop a DMT-influenced dance program for adult day programs for persons with dementia, which provides a seated format ballroom dance program that can be facilitated without a dance partner and can be facilitated by a non-DMT care provider. To address the purpose and the questions expressed previously, information was gathered with collaborator help and the data was analyzed for the creation of the program. The

Delphi method was administered for information gathering. The design of the program followed the theory approach logic model, which used the Delphi method to aid in developing the program. This chapter further explains how the Delphi method and the theory approach logic model were applied in this project (Hsu & Sandford, 2007).

Collaborators

To develop this program, collaborators were recruited from an adult day program for persons with dementia. There were four collaborative professionals—three dance/movement therapists and one non-DMT program manager—all of which have experience with providing person-centered care. The purpose of involving these professionals was to gain more perspective about the site, the population for whom the program was being developed and to cultivate ideas and benefits for the program.

Recruitment procedure. Collaborators were resourced through this writer’s internship site. These relationships included current colleagues and coworkers. Recruitment began in an informal manner with conversations about the program goals, the process of this program development and the significance of the knowledge each collaborator could contribute to the project. Collaborators were then asked to sign an informal collaborator agreement (see Appendix

26 C), which further explained expectations, goals and the overall process for creating a program intended for implementation.

Setting. Collaboration with the professionals at this internship was held in private offices at the site for convenience and to maintain confidentiality. Meetings with the collaborators were flexible; depending on their availability, preferences and needs. Information interpretation occurred in a private space.

Information Gathering

The Delphi method is a form of qualitative data gathering sought to gain a consensus among the experts (Hsu & Sandford, 2007). The process for this study utilized three rounds of this method. It began with the first questionnaire, then an informal interview to discuss any questions and comments about the information collected, and ended with a final questionnaire to address details and information for the supplementary video. Each round consisted of qualitative questionnaires based on the information gathered from the previous rounds. According to the

Delphi method presented by Hsu & Sandford (2007), the first round consisted of general questions, followed by more specific questions on the program itself. The program logic model and feedback in the final round were then implemented.

In order to develop a sustainable and effective program, adequate information from collaborators in the field was necessary. The information presented by collaborators was collected through multiple rounds. The first questionnaire aimed to gather information about possible external factors that can or cannot be controlled by the developer, important objectives to address, an effective format and design of the program, and implementation challenges and strategies (see Appendix E). Then, informal interviews were conducted to discuss the collaborators’ answers. Finally, a second questionnaire was administered to incorporate

27 information from the previous rounds to include data on the effectiveness of the supplementary video. Collaborators were asked questions about whether or not the materials supported the presented information and if such materials can be utilized by dance/movement therapists and other care providers (see Appendix F).

Questionnaires were exchanged via email; however, this was flexible depending on preferences and availability of the collaborators. Collaborators answered the questionnaires in the form of a Word document to the best of their ability. After having an informal interview— during which discussion about the questions, their answers and possible further explanation/feedback occurred—collaborators answered one final questionnaire in the form of a

Word document, which was based off of their input from the previous rounds, and included validation pertaining to the development of the supplementary video.

Round 1. This round began the questionnaire process (see Appendix E). The questionnaire was drafted to describe thoughts about the development of the program and initial information encompassing the design and outlook for its purpose and foundation. This questionnaire included a variety of topics such as goals and objectives, session information and format, cultural factors, necessary resources, safety practices, external factors, and obstacles, etc.

From Round 1, input was gathered on specific goals and objectives most important to address, when and where the session could take place, what would be available for this writer to utilize, and how to navigate any safety concerns and potential hurdles.

Round 2. This next round was an informal interview in which each collaborator was interviewed individually; discussions about answers to the questionnaire ensued. Meetings were held in a private office space. During the interviews, any questions that were not answered were

28 clarified as well as ways to further address any concerns about the program, and ways to further develop an effective and sustainable program.

Round 3. The final round ended the questionnaire process (see Appendix F). All of the information presented above were integrated and concretized to develop the program. This round aimed to address any missing links and further concerns that may have surfaced after viewing the supplementary video as well as the supplementary PowerPoint presentations (see Appendix H).

Program plans based on the information via the logic model was created, and the curriculum of the program included validation via the Delphi method.

Approach

The development of this program used a theory approach logic model (see Appendix D).

This basic logic model provided a visual illustration, which addressed how the program was developed to organize the needs in addressing the necessary resources to implement the program, create the activities and to interpret expected outcomes (W.K. Kellogg Foundation, 2004). The process was organized into individual categories: resources/inputs, activities/outputs, outcomes and impact. The idea of these categories provided a guideline for the work and mapped the potential results of the program (W. K. Kellogg Foundation, 2004). This also provided the identification of potential limitations and external factors beyond the limits; which could not be controlled by the developer and may affect the results of the program (Taylor-Powell, Jones, &

Henert, 2003). According to W. K. Kellogg Foundation (2004), this model specifically highlighted the assumptions made by the developer that were supported in the developer’s individual theoretical approach.

The logic model was useful to categorize the information into an efficient way of understanding and organizing the information to develop the program (W. K. Kellogg

29 Foundation, 2004). This model helped to provide the necessary and essential information of potential limitations and any external factors that may affect the results of the program (Taylor-

Powell, Jones, & Henert, 2003). Because there are external factors that cannot be controlled, it was important to utilize this model to organize and address the possible resources available and to address what would be necessary to implement the program.

Resources/inputs. According to W. K. Kellogg Foundation (1998), “Resources include the human, financial, organization, and community resources a program has available to direct toward doing the work. Sometimes this component is referred to as Inputs,” (p. 2). The collaborators provided the following information as resources/inputs. For human resources: they are any care provider with the knowledge and experience in person-centered care. At least two care providers during a session are ideal; however, collaborators agreed that more staff presents will ensure participant safety. For financial resources: having proper equipment such as a sound system to play music, headset to ensure the participants can properly hear any directives, appropriate chairs with armrests, and refreshments to aid in physical activity. For organizational resources: having a day program for older adults with dementia includes a fairly consistent daily routine with reminders of the schedule, a safe space that is up to code and up to standards, and appropriate timing of forty-five to sixty minutes per session. The organizational structure was comprised of consistent staff presence with five to fifteen participants in each session.

Program activities. “Program activities are what the program does with the resources.

Activities are the processes, tools, events, technology and actions that are an intentional part of the program implementation. These interventions are used to bring about the intended program changes or results,” (W.K. Kellogg Foundation, 1998, p. 2). The event of the activities followed

Marian Chace’s technique of a warm-up, theme development and closure (Levy, 2005), which is

30 presented in Chapter Four. The tools for the activity included the knowledge of person-centered care and the experience a care provider should have to facilitate an effective session.

Dance/movement therapists will have the knowledge and experience to synthesize the program into DMT.

The process to facilitate the activity depends on the person facilitating it. If the facilitator is a non-DMT care provider, then they are encouraged to review and follow the supplementary video, which provides movement samples. If the clinician is a dance/movement therapist, then they can use the M3 curriculum as well as any DMT tools they wish to facilitate in their session.

In terms of technology, the activity will be most effective with using the music lists provided in the curriculum, the supplementary video as a guide, and safe equipment during the session.

Outputs. “Outputs are the direct products of program activities,” (W.K. Kellogg

Foundation, 1998, p. 2), which included the targeted population and the specific activities to be conducted (Taylor-Powell, Jones, & Henert, 2003). The targeted population was older adults with dementia in an adult day program. These participants attended the day program at least two to three times per week and had consistent programing, had the same care providers, and were in a safe and controlled setting with roughly the same participants each day.

The direct product from the planned work, including the available resources, was a curriculum providing activity descriptions, music examples, background information and trivia, sample clip references and DMT interventions; PowerPoint slides with pictures, dance information and sample clips; and a supplementary video of each dance lesson providing seated movement examples. The video was created with the help of separate collaborators who were involved in the making, dancing, and editing of the video (see Appendix G for video agreement).

31 Outcomes. “Outcomes are the specific changes in program participants’ behavior, knowledge, skills, status and level of functioning,” (W.K. Kellogg Foundation, 1998, p. 2). The outcome for this program revisited the purpose of this project, which aims to support creative expression, reminiscence and socialization. The program will utilize DMT-based practices along with person-centered care as the foundation of the program. Creative expression will be elicited from the ballroom dance movements in tandem with DMT practices. Reminiscence will be elicited from possible familiar movements and music. Socialization will be elicited from the nature of ballroom dancing and being in a group setting.

Information Analysis

Information was interpreted throughout the process of the Delphi Method, during which collaborator input from the first questionnaire and interview was considered and analyzed. Then, the second questionnaire was a synthesized product based on their answers and the integration of information, which posed a more formal program development project. Finally, the consensus from the collaborators was integrated into the Logic Model, which addressed the inputs and outputs of this program development project. Implementation of DMT, ballroom dance movements, and/or supplementary material can support creative expression, reminiscence and socialization as the outcome as indicated by quality of life.

Presentation

The presentation was a program curriculum (see Chapter Four). Program evaluation suggestions are further described in Chapter Five. The program includes supplementary videos showing guidelines of potential dance movements, supplementary PowerPoint presentations (see

Appendix H) of background information of each dance style and suggested music.

32 Chapter Four: The Manzano Movement Method (M3)

Lesson 1: Waltz

I. Focus A. Exertion and recuperation with breath B. Flowing with gracefulness, elegance, and etiquette

II. Activity Description: The activity will start with a warm-up, which will introduce the music and segue into a short discussion. Background information may be given, and participants will be encouraged to identify any memories and feelings, and to explore creative movement in a social context. The instructional portion of the dance will then begin. After movement, discussion will continue, and verbal/nonverbal processing will conclude the session.

Accompanying PowerPoint: https://www.youtube.com/watch?v=2Y6SfCJBSJI

III. The Lesson A. Introduction (estimated time: 15 minutes) 1. Initial Check-in a. Check-in with participants individually b. Introduce the curriculum and the setting of the group c. Express any safety precautions 2. Body-part Warm-up a. Use music (see section IV for song suggestions) b. Lead group in moving each part of the body c. Integrate all body parts into movement 3. Transition a. Check-in with participants b. Presenting questions: i. What does this remind you of? ii. How does this make you feel? B. Main Activity (estimated time: 30 minutes) 1. See video at 0:13 for movement examples C. Closure (estimated time: 15 minutes) 1. Final Check-in a. Facilitate general check-in with participants i. Bring awareness to body-felt experience ii. Explore immediate responses and feelings from activity 2. Recap a. Provide overview i. Validate experience ii. Capture individual and collective experience 3. Conclusion a. Facilitate movement(s) with shared experience into closing ritual

33 IV. Music: Tennessee Waltz Dark Waltz – Katy Lootens The Last Waltz – Engelbert Humperdinck Moon River – Audrey Hepburn & Henry Mancini Way Over Yonder – Carole King Try to Remember – The New 101 Strings Orchestra Are You Lonesome Tonight – Elvis Presley Fascination – Nat King Cole Could I Have This Dance – Anne Murray You Light Up My Life – Debby Boone

V. Supplementary Information A. History: The waltz was born from peasants in the suburbs of Vienna and in the alpine region of Austria. As early as the 17th century, waltzes were played in the ballrooms of the Hapsburg court. During the middle of the eighteenth century, the allemande form of the waltz was very popular in France and soon became an independent dance and the close-hold was introduced. By the end of the 18th century, the Austrian peasant dance had been accepted by high society. The waltz was criticized on moral grounds by those opposed to its closer hold and rapid turning movements. Religious leaders almost unanimously regarded it as vulgar and sinful. In July of 1816, the waltz was included in a ball given in London by the Prince Regent. Popularity increased, and the bourgeoisie took it up enthusiastically immediately after the French Revolution. The first time the waltz was danced in the United States was in Boston in 1834 by Lorenzo Papanti, a Boston dancing master. By the 19th century, the waltz was firmly established in United States society (Central Home Company Inc., 2018). B. Interesting Facts 1. “The word, “waltz” comes from the old German word walzen, which means to roll, turn, or to glide,” (Hastie, 2006, para 1). 2. “Queen Victoria was a keen and expert ballroom dancer with a special love of the waltz,” (Central Home Company Inc., 2018, para 17). 3. Viennese composers Johann Strauss I and Lanner were first popular throughout Europe. Beethoven, Schubert, and Hummel wrote waltzes. Weber's ‘Invitation to the Dance’ is in waltz rhythm and is the first formal structure of the waltz (Kiddle Encyclopedia, 2018). C. Sample Clips 1. Country Western Waltz https://www.youtube.com/watch?v=Og77wjnJn-Q 2. International Slow Waltz https://www.youtube.com/watch?v=G8WKO6oEOag 3. Viennese Waltz https://www.youtube.com/watch?v=JrwmbcI9yPE

34 VI. Interventions for Dance/Movement Therapists A. Rise and Fall / Exertion and Recuperation 1. Use different body parts to reflect the “rise and fall” of waltz 2. Create the motion using a single body part, multiple body parts, then sequential and successive body movements 3. Movements can be done using Bartenieff’s Fundamental Patterns of Total Body Connectivity (Hackney, 2002). a. Begin with breath and facilitate the breathing using the rising and falling action of the waltz 4. Guiding questions: a. What is your experience when the body rises? i. Connect rising movements with how one might rise to an occasion b. What is your experience when the body falls? i. Connect falling movements with how one might come down from being in a high state of mind c. Why does the body rise after falling? i. Explore situations of resilience d. Why does the body fall after rising? i. Explore recuperation from using effort in doing something B. Flow 1. Use different body parts to move to the feeling of the waltz music— creating flow, as described through Laban Movement Analysis (Moore, 2014). 2. Create motion using a single body part, multiple body parts, then sequential and successive body movements 3. Movements can be done using Bartenieff’s Fundamental Patterns of Total Body Connectivity (Hackney, 2002). 4. Guiding questions: a. How does it feel to flow through the body? i. Explore how one might ‘flow’ through life b. Are your movements bound or free? i. Explore situations in which they felt stuck or have had the freedom to move about

35 Lesson 2: Latin Dance

Lesson 2a: Cha Cha

I. Focus A. Rhythm and Patterning

Accompanying PowerPoint: https://www.youtube.com/watch?v=eGSA53_qRys

III. The Lesson A. Introduction (estimated time: 15 minutes) 1. Initial Check-in a. Check-in with participants individually b. Introduce the curriculum and the setting of the group c. Express any safety precautions 2. Body-part Warm-up a. Use music (see section IV for song suggestions) b. Lead group in moving each part of the body c. Integrate all body parts into movement 3. Transition a. Check-in with participants b. Presenting questions: i. What does this remind you of? ii. How does this make you feel? B. Main Activity (estimated time: 30 minutes) 1. See video at 3:40 for movement examples C. Closure (estimated time: 15 minutes) 1. Final Check-in a. Facilitate general check-in with participants i. Bring awareness to body-felt experience ii. Explore immediate responses and feelings from activity 2. Recap a. Provide overview i. Validate experience ii. Capture individual and collective experience 3. Conclusion a. Facilitate movement(s) with shared experience into closing ritual

36 IV. Music: Oye Como Va - Santana Sway – Michael Bublé Daddy – Della Reese September – Earth, Wind, & Fire Todo, Todo, Todo – Daniela Romo Love Potion #9 – Hansel Martinez Loco in Acapulco – Four Tops Maria – Ricky Martin Pata Pata – Miriam Makeba Chilly Cha Cha – Jessica Jay Respect – Aretha Franklin Shalala Lala (Hitradio) – Vengaboys What a Fool Believes – Matt Bianco Tea for Two (Cha Cha) – Enzo Squillino Jr. & His Latin “Baton”

V. Supplementary Information A. History: The cha-cha-cha, or simply cha cha in the U.S., originated from Cuba. In the early 1950s, Enrique Jorrin was a violinist and composer who performed at the dance halls in Havana where they play various dance styles such as the danzon- mambo for dance-oriented crowds. Jorrin noticed the difficulty the dancers were having with dancing to some of the syncopated rhythms. In order to make his music more appealing to the dancers, he began composing songs in which the rhythm was less syncopated. The group he played with, Orquesta America, performed these new compositions at the Silver Star Club in Havana, and noticed the dancers had improvised a new triple step in their footwork. The name of the dance is an onomatopoeia derived from the shuffling sound of the dancers’ feet. Thus, the new style of dance became known as the “cha cha cha,” and became associated with a triple step patterned dance. In 1953, Orquesta America released two of Jorrin’s new compositions, “La Enganadora” and “Silver Star,” the first ever cha cha compositions ever recorded. The cha cha craze spread from Havana to Mexico City and throughout Latin America. The U.S. and Western Europe followed soon after (Dancing with the Stars Wiki, 2018). B. Interesting Facts 1. The cha cha is related to the mambo. After the craze spread throughout Latin America, the U.S. and Western Europe followed soon after just as they did with the mambo craze a few years earlier (New World Encyclopedia, 2018). C. Sample Clips 1. Club Cha Cha https://www.youtube.com/watch?v=2EY-dEGbmK8 2. American Cha Cha https://www.youtube.com/watch?v=5xXqrrhCf8E 3. International Cha Cha https://www.youtube.com/watch?v=-zJGgYVAWy8

VI. Interventions for Dance/Movement Therapists (Note: This lesson is similar to Lesson 2b: Rumba; however, the overall feeling is more playful with faster speeds. Explore the speeds using exertion and recuperation as described in the Section VI of Lesson 1: Waltz.) A. Group Rhythmic Activity via Patterning 1. Use the beat of the cha cha to create movements 2. Establish the beat using counts 3. Begin by using rhythmic movements such as claps and pats to find the cha cha rhythm 4. Explore creative movements using cha cha timing 5. Explore size of movement a. Use large movements with the single counts b. Use small movements with the syncopated counts 6. Explore different movement variations and patterns of the “cha-cha-cha” a. Different locations in space b. Different shapes using a variety of body parts 7. Guiding questions: a. How does it feel to move to a quick “cha-cha-cha” beat? i. Explore experience of the speed and how one may feel moving quickly b. How are your movements compared with others? i. Explore movements that are similar to others and explore what made them similar and why. Explore how those movements may reflect daily routines and how they connect with others in life c. How are your movements different from others? i. Explore movements that vary from others and explore what made them different and why. Explore how those movements express individuality, yet how each person contributes to community and society d. How did it feel to move to the beat with others? i. Explore unity and community e. Why did we create movements in unison? i. Connect patterns of movement to group rhythmic activity and creating harmony f. Why were some movements bigger than others? i. Connect sizes of movements to exertion and recuperation. Explore what things in life can be done little by little or big and slow

38 Lesson 2: Latin Dance

Lesson 2b: Rumba

I. Focus A. Group Cohesion and Community

Accompanying PowerPoint: https://www.youtube.com/watch?v=ZqMSJzWZLCY

III. The Lesson A. Introduction (estimated time: 15 minutes) 1. Initial Check-in a. Check-in with participants individually b. Introduce the curriculum and the setting of the group c. Express any safety precautions 2. Body-part Warm-up a. Use music (see section IV for song suggestions) b. Lead group in moving each part of the body c. Integrate all body parts into movement 3. Transition a. Check-in with participants b. Presenting questions: i. What does this remind you of? ii. How does this make you feel? B. Main Activity (estimated time: 30 minutes) 1. See video at 5:48 for movement examples C. Closure (estimated time: 15 minutes) 1. Final Check-in a. Facilitate general check-in with participants i. Bring awareness to body-felt experience ii. Explore immediate responses and feelings from activity 2. Recap a. Provide overview i. Validate experience ii. Capture individual and collective experience 3. Conclusion a. Facilitate movement(s) with shared experience into closing ritual

39 IV. Music: Besame Mucho – Andrea Bocelli Emotion – Samantha Sang, Bee Gees Spanish Eyes – Engelbert Humperdinck Perhaps, Perhaps, Perhaps – Doris Day Somethin’ Stupid – Frank Sinatra w/ Nancy Sinatra El Reloj – Luis Miguel Sway (Quien Sera) – Dean Martin Under the Boardwalk – The Drifters Kokomo – The Beach Boys Stand by Me – Ben E. King

V. Supplementary Information A. History: The rumba is a combination of several popular dances from Cuba. Using pulsating dance rhythms, the origin can be traced back to African ceremonial and religious dances. The dance first came to the U.S. in 1913. Since WWII, the rumba was reformed into a slower version. In 1935, George Raft starred in, “Rumba,” a movie in which he played a suave dancer who wins the heart of a lady, played by Carole Lombard. The rumba’s unique styling and romantic character became popular amongst the ballroom community and has retained its popularity ever since (Dance Lovers, 2015). B. Interesting Facts 1. In 2016, UNESCO added the rumba to the Representative List of the Intangible Cultural Heritage of Humanity (Intergovernmental Committee of UNESCO, 2016). 2. An older version of the dance, called the rural rumba, is a pantomimic dance, which mimics the movements of various barnyard animals (WikiDanceSport, 2018). C. Sample Clips 1. American Rumba https://youtu.be/T1csVjAQvNg 2. International Rumba https://youtu.be/HZUVjH7XpMM

VI. Interventions for Dance/Movement Therapists (Note: This lesson is similar to Lesson 2a: Cha Cha; however, the overall feeling is sensual and intimate with slower speeds. Explore the quick and slow speeds and how they relate to relationships and daily tasks.) A. Group Harmony-Relationship via Synchronicity 1. Use the beat of the rumba to create movements 2. Establish the beat using counts 3. Begin by using rhythmic movements such as claps and pats to find the rumba rhythm 4. Explore creative movements using rumba timing 5. Explore size of movement

40 a. Use large movements with the slow count b. Use small movements with the quick counts 6. Guiding questions: a. How does it feel to move to the slow counts? i. Connect experience/emotion to moving slowly b. How does it feel to move to the quick counts? i. Connect experience/emotion to moving quickly c. How are your movements compared with others? i. Explore movements that are similar to others and explore what made them similar and why. Explore how those movements may reflect daily routines and how they connect with others in life d. How are your movements different from others? i. Explore movements that vary from others and explore what made them different and why. Explore how those movements express individuality, yet how each person contributes to community and society e. How did it feel to move to the beat with others? i. Explore unity and community f. Why did we create movements in unison? g. Why were some movements bigger than others, and why were some movements smaller than others? i. Connect sizes of movements with speed, and explore how that connects to what relationship means and to things done in daily life

41 Lesson 3: Tango

I. Focus A. Connection/Relationships and Emotions B. Wants and Desires

Accompanying PowerPoint: https://www.youtube.com/watch?v=QvdjrE6IzN4

III. The Lesson A. Introduction (estimated time: 15 minutes) 1. Initial Check-in a. Check-in with participants individually b. Introduce the curriculum and the setting of the group c. Express any safety precautions 2. Body-part Warm-up a. Use music (see section IV for song suggestions) b. Lead group in moving each part of the body c. Integrate all body parts into movement 3. Transition a. Check-in with participants b. Presenting questions: i. What does this remind you of? ii. How does this make you feel? B. Main Activity (estimated time: 30 minutes) 1. See video at 8:13 for movement examples C. Closure (estimated time: 15 minutes) 1. Final Check-in a. Facilitate general check-in with participants i. Bring awareness to body-felt experience ii. Explore immediate responses and feelings from activity 2. Recap a. Provide overview i. Validate experience ii. Capture individual and collective experience 3. Conclusion a. Facilitate movement(s) with shared experience into closing ritual

42 IV. Music: Santa Maria (del Buen Ayre) by Gotan Project La Cumparsita – Julio Iglesias Hernando’s Hideaway – Claudius Alzner Whatever Lola Wants – Sarah Vaughan & Gotan Project Por Una Cabeza – New 101 Strings Orchestra Libertango – Bond El Choclo – New 101 Strings Orchestra Jealousy – New 101 Strings Orchestra Cell Block Tango (from “Chicago”) by Catherine Zeta-Jones Phantom of the Opera – Phantom of the Opera

V. Supplementary Information A. History: Tango is a partner dance that originated in the 1880s along the River Plate, the natural border between Argentina and Uruguay, and soon spread to the rest of the world. Early tango was known as tango criollo or Creoletango. Initially, it was just one of the many dances, but it soon became popular throughout society, as theatres and street barrel organs spread it from the suburbs to the working-class slums, which were packed with hundreds of thousands of European immigrants. In the early years of the 20th century, dancers and orchestras from Buenos Aires travelled to Europe, and the first European tango craze took place in Paris, soon followed by London, Berlin, and other capitals. Towards the end of 1913 it hit New York City in the US, and Finland (Arthur Murray NYC, 2017). B. Interesting Facts 1. In 2009, UNESCO added the tango to the Representative List of the Intangible Cultural Heritage of Humanity (Intergovernmental Committee of UNESCO, 2009). 2. There are more than fifteen styles of tango (Arthur Murray NYC, 2017). 3. Albert Newman developed the American Tango, originally the “Minuet” tango in 1914 (New World Encyclopedia, 2014). C. Sample Clips 1. Argentine Tango https://www.youtube.com/watch?v=Gcs4LY_ljQk 2. American Tango https://www.youtube.com/watch?v=o6cUois9t08 3. International Tango https://www.youtube.com/watch?v=wYYKlf_4NI8

VI. Interventions for Dance/Movement Therapists A. Connection/Relationships via Body and Emotions 1. Use movements that accompany the feeling of the music a. Quick, staccato movements b. Movements that utilize near and far reach space of the body c. Sensual movements in near reach kinesphere

43 2. Use movements to facilitate sizes of kinespheres and relationships with others a. Movements that utilize near and far reach space of the body b. Sensual movements in near reach kinespheres c. Movements that are light and welcoming vs. strong and dismissive or a combination of either 3. Guiding questions: a. In what kind of relationships/boundaries could you exercise these movements? b. How did it feel to create movement close to or far from the body? i. Connect movements to emotions and how it is to feel a connection to those movements c. How did the movements make you feel? i. Explore the emotional connections to the self and to others d. How can you connect to/disconnect from others with your movements? i. Explore this with different types of relationships e. Where in your body did you feel most comfortable moving? i. Connect these movements to boundaries and limits of movement in daily living and when exercised with others f. Who is involved? i. Explore reminiscence of people in their lives and the relationships they have/had g. Who do you love? i. Explore reminiscence of people in their lives and the relationships they have/had B. Wants and Desires via Yield-Reach/Push-Pull 1. Use movements that will explore an intent to want or desire something tangible or intangible 2. Explore the feeling of the movement with intensity and emotion 3. Explore movements with far and near reach space a. Explore how movements can be used to attain something that is wanted or desired 4. Movements can be done using Bartenieff’s Fundamental Patterns of Total Body Connectivity (Hackney, 2002). 5. Use movements to create the need and desire to attain and pull something in, whether tangible or intangible 6. Use movements to create the need and desire to push back or push away something that is unwanted, whether tangible or intangible 7. Guiding questions: a. Explore the movements they used, whether near or far reach space, and bring awareness to parts of the body that were held or active in order to explore the parts that are present or withdrawn i. What is it that you want or desire? ii. What is it that you like or dislike? iii. What can you do to achieve or attain it?

44 iv. How can you pursue this? v. Why would you want/desire that? b. Explore movements that can reflect current state to support normalcy i. How can you relate this to everyday life? ii. Where do you see yourself doing this now? c. Who is/was involved? i. Explore this on an emotional level in order to support a higher awareness of body-felt experience and reminiscence

45 Lesson 4: Big Band Ballroom

Lesson 4a: Foxtrot

I. Focus A. Creativity and Celebration B. Reminiscence of the Big Band era and the Rat Pack

Accompanying PowerPoint: https://www.youtube.com/watch?v=STwXcoG2o6Q

III. The Lesson A. Introduction (estimated time: 15 minutes) 1. Initial Check-in a. Check-in with participants individually b. Introduce the curriculum and the setting of the group c. Express any safety precautions 2. Body-part Warm-up a. Use music (see section IV for song suggestions) b. Lead group in moving each part of the body c. Integrate all body parts into movement 3. Transition a. Check-in with participants b. Presenting questions: i. What does this remind you of? ii. How does this make you feel? B. Main Activity (estimated time: 30 minutes) 1. See video at 10:41 for movement examples C. Closure (estimated time: 15 minutes) 1. Final Check-in a. Facilitate general check-in with participants i. Bring awareness to body-felt experience ii. Explore immediate responses and feelings from activity 2. Recap a. Provide overview i. Validate experience ii. Capture individual and collective experience 3. Conclusion a. Facilitate movement(s) with shared experience into closing ritual

46 IV. Music: It Had to be You – Harry Connick, Jr. Fly Me to the Moon – Frank Sinatra You Make Me Feel So Young – Michael Bublé I’ve Got You Under My Skin – Frank Sinatra Let There be Love – Nat King Cole I Got Rhythm – Lena Horne The Best is Yet to Come – Tony Bennett Call Me Irresponsible – Bobby Darin Ain’t that a Kick in the Head – Dean Martin That’s You – Nat King Cole Witchcraft – Frank Sinatra Fever – Ray Charles & Natalie Cole Cheek to Cheek – Doris Day Come Dance with Me – Frank Sinatra Come Fly with Me – Frank Sinatra

V. Supplementary Information A. History: The dance was premiered in 1914, quickly catching the eye of the husband and wife duo, Vernon and Irene Castle, who lent the dance its signature grace and style. The origin of the name of the dance is unclear, although one theory is that it took its name from its popularizer, the vaudeville actor, Harry Fox. The Castles were intrigued by the rhythm of the music and created a slow dance to go with it. They initially introduced the dance as the “Bunny Hug.” Shortly after, they went abroad and in mid-ocean, sent a wireless message to the magazine to change the name of the dance to the “foxtrot.” It was subsequently standardized by Arthur Murray, in whose version it began to imitate the positions of Tango. At its inception, the foxtrot was originally danced to ragtime music. From the late 1910s through the 1940s, the foxtrot was the most popular fast dance, and a vast majority of records issued during these years were foxtrot. Over time, the foxtrot split into slow and quick versions, referred to as “foxtrot” and “quickstep” respectively. In the slow category, further distinctions exist between the International style “slow foxtrot” or “slowfox” and the American style (Kiddle, 2018). B. Interesting Facts 1. The original name of the foxtrot was the “Bunny Hug” (WikiDanceSport, 2016). 2. The foxtrot was named after Harry Fox (Kiddle, 2018). 3. During its inception, the foxtrot was more popular than both the waltz and tango (WikiDanceSport, 2016). 4. The foxtrot and swing can sometimes be danced to the same music stylings (WikiDanceSport, 2016).

47 C. Sample Clips 1. American Foxtrot https://www.youtube.com/watch?v=9LvyLnhAOkI 2. International Foxtrot https://www.youtube.com/watch?v=IGeeaIdnBc8 3. Quickstep https://www.youtube.com/watch?v=KcBop6cQV_k

VI. Interventions for Dance/Movement Therapists (Note: This lesson is similar to Lesson 4b: Swing, especially since music choice can overlap. This lesson is specifically designed to elicit reminiscence of celebrating and to support celebration. Speeds may vary as well; however, foxtrot is generally done to the slower music selections.) A. Creative Movement and Celebration 1. Explore nonverbal creative expression with Big Band music and the era of the Rat Pack 2. Explore movement through reminiscence of attending parties, celebration, and iconic events (i.e. weddings, graduations, birthdays, and anniversaries) a. Large movements for the times when an individual wanted to celebrate and stand out b. Small movements for being flirtatious and playful with others c. Various movements with different Effort qualities to express the type of person they are when they are expressing, celebrating, and being at different types of functions 3. Guiding questions: a. What parts of the body are held? i. Bring awareness to parts of the body that may be withdrawn and invite those parts to move and celebrate b. What parts of the body are active? i. Bring awareness to parts of the body that may be engaged and invite those parts to grow c. How does this movement reflect who you are? i. Explore each person’s individuality and identity and hold the space with support d. How does this movement reflect a memory from your past? i. Support reminiscence of celebration and explore how they can continue to celebrate e. Why does this movement represent a part of you? i. Celebrate the person for who they are and validate f. Who were you celebrating? i. Explore movements on a relational level to self and other. Invite participant to continue celebrating the past and present

Lesson 4: Big Band Ballroom

Lesson 4b: Swing

I. Focus A. Creativity and Play B. Reminiscence of the Big Band era and Rock & Roll

Accompanying PowerPoint: https://www.youtube.com/watch?v=7MluIP-iDVc

III. The Lesson A. Introduction (estimated time: 15 minutes) 1. Initial Check-in a. Check-in with participants individually b. Introduce the curriculum and the setting of the group c. Express any safety precautions 2. Body-part Warm-up a. Use music (see section IV for song suggestions) b. Lead group in moving each part of the body c. Integrate all body parts into movement 3. Transition a. Check-in with participants b. Presenting questions: i. What does this remind you of? ii. How does this make you feel? B. Main Activity (estimated time: 30 minutes) 1. See video at 12:42 for movement examples C. Closure (estimated time: 15 minutes) 1. Final Check-in a. Facilitate general check-in with participants i. Bring awareness to body-felt experience ii. Explore immediate responses and feelings from activity 2. Recap a. Provide overview i. Validate experience ii. Capture individual and collective experience 3. Conclusion a. Facilitate movement(s) with shared experience into closing ritual

49 IV. Music: That’ll Be the Day – Buddy Holly Be-Bop-A-Lula – Gene Vincent Puttin’ on the Ritz The Lady is a Tramp – Sammy Davis Jr. Don’t Go Breaking My Heart – Elton John Lollipop – Chordettes The Locomotion – Little Eva Chatanooga Choo Choo – Glenn Miller Great Balls of Fire – Jerry Lee Lewis Jailhouse Rock – Elvis Shake, Rattle, & Roll – Bill Haley and the Comets Boogie Woogie Bugle Boy – The Andrew Sisters In the Mood – Glenn Miller Rockin’ Robin – Bobby Day Zoot Suit Riot – Cherry Poppin’ Daddies Blue Suede Shoes – Elvis Rock Around the Clock – Bill Haley All Shook Up – Elvis Crazy Little Thing Called Love – Queen Sing, Sing, Sing – Benny Goodman

V. Supplementary Information A. History: Swing dance developed with the swing style of jazz music in the 1920s-1940s. During the swing era, there were hundreds of styles of swing dancing, but those that have survived beyond that era include: Lindy Hop, Balboa, Shag, Jitterbug, and Charleston. The most well-known is the Lindy Hop, which originated in Harlem in the early 1930s. The majority of the swing dances began in African American communities. The Jitterbug is referred to as the umbrella term for swing dancing, as the term was famously associated with swing era band leader Cab Calloway because “[The dancers] look like a bunch of jitterbugs out there on the floor due to their fast, often bouncy movements” (Turtoga, 2018, p. 11). Swing dancing has evolved into various styles depending on the region where it originated from such as: Carolina Shag, East Coast Swing, West Coast Swing, and Jive (Turtoga, 2018). B. Interesting Facts 1. “Swing is dancing’s greatest equalizer. If dances were people, swing would be a civil rights pioneer. When it first emerged, New Yorkers of all ethnic background united to enjoy the dance and music,” (Suzy, 2014, para 7). 2. Swing competitions are divided into categories (Suzy, 2014). a. Strictly i. Partners remain in contact with each other and the floor b. Showcase i. Pairs of groups perform choreographed routines

50 c. Jack and Jill i. Individual competitors are randomly paired off d. West Coast i. Partners come together and separate in “elastic” motions e. East Coast i. Ballroom style, with stricter-than-usual attention to form C. Sample Clips 1. Jitterbug https://www.youtube.com/watch?v=OEcOgLsNkwE 2. West Coast Swing https://www.youtube.com/watch?v=cTyg2lE95XE 3. Jive https://www.youtube.com/watch?v=tc3n3K55UNM

VI. Interventions for Dance/Movement Therapists (Note: This lesson is similar to Lesson 4a: Foxtrot, especially since music choice can overlap. This lesson is specifically designed to elicit reminiscence of having fun and to support opportunities for fun. Speeds may vary as well; however, swing can be done to faster music.) A. Creative Movement and Play 1. Explore nonverbal creative expression with Big Band music and the era of the Rat Pack 2. Explore movement through reminiscence of having fun, being silly, and playing a. Large and small movements to express their inner child and willingness to express in a fun, yet open environment b. Various movements with different Effort qualities to express the type of person they are when they are expressing and enjoying life in different types of situations 3. Guiding questions: a. What parts of the body are held? i. Bring awareness to parts of the body that may be withdrawn and invite those parts to move and have fun b. What parts of the body are active? i. Bring awareness to parts of the body that may be engaged and invite those parts to grow c. What parts of the body want to move (or not move)? i. Explore participant’s willingness to have fun and let loose d. How does this movement reflect who you are? i. Explore each person’s individuality and identity and hold the space with support e. Who were you with? i. Invite participant to think of time and place when they were smiling and having fun, and to think of who they were with in order to bring fun into the present moment

51 Chapter Five: Discussion

Implementation

Implementation can take place in any clinical environment with an older adult population. These settings may include nursing homes, senior homes, day programs, hospitals and private practice, etc.

Implementation will require proper programming within the setting and its facilitators. In order to implement, the agency for which the program will be facilitated must understand and adhere to any safety and ethical factors.

Implementation requires proper resources as explained in the methods section. The setting must include sturdy chairs with armrests, so the participants can safely sit in and utilize for extra stability. To implement the program, there must be a way to play music either through a stereo or speaker. Having refreshments such as water is important to have after the session.

Because the program uses physical movement, it is vital for the participants to stay hydrated.

Challenges for implementation. Time can be a challenge as it was expressed by the collaborators that each session should run between forty-five to sixty minutes long. If the session is under forty-five minutes, it will be too short and there will be no time to effectively process the participants’ experiences. If the time goes beyond sixty minutes, it will be too lengthy of a session and participants can become anxious and disengaged. If the agency or facility is unable to have the right amount of time to fit into the day, then the program may be difficult to facilitate as it would take at least an hour to facilitate. M3 facilitators may consider utilizing the same lesson over a number of sessions to fully engage in the content and experiences of the lesson.

This way, even if time is short, all components of the curriculum can be utilized. Additionally, the more the participants partake in one style of dance, the repetition will support how they feel

52 in their movements, and participants will have more time to effectively process their experiences.

Time of day plays a factor as well. A session that runs at the end of the day can be challenging for participants who may experience sundowning, as described in Chapter Two. Sundowning may also lead to feelings of anxiety, restlessness and confusion. Therefore, the facilitator may consider M3 sessions to occur in the morning or early afternoon.

Proper staff to participant ratio can be a challenge as well. The lack of resources/organization can mean a deficit of staff members per the number of participants. If the ratio of participants to staff members is high, then it might be unsafe to facilitate the program in case a participant with mobility challenges has the urge to stand up and dance or if there is a medical emergency. Again, at least two staff members are recommended for M3 implementation.

Without a big enough space, one that is enclosed and comfortable, the location may not be able to accommodate the number of participants.

Participants themselves can pose a challenge when implementing the program. Some people may genuinely be uninterested. This could be because the participant would rather do a different type of activity such as art or watching a video documentary/presentation. Though, M3 is geared towards this generation’s music and movements, therefore, any person inclined towards music and movement would probably choose M3 as a regular session.

An individual’s preconceived notions of what ballroom dance is can be an obstacle.

Participants who only know and understand ballroom dance as an activity that requires a standing position on two feet and with a partner can be difficult to accommodate as this can be both a physical hazard and does not fit the curriculum of the program. It is important that the facilitator and the agency markets the M3 sessions as a seated ballroom dance experience—one that does not require a partner and no experience is necessary.

53 Facilitator knowledge and experience with the ballroom styles, dance and movement can pose a challenge in implementation. Due to this, M3 has the supplementary video, so if the facilitator is not comfortable with movement nor has dance experience, they can use the video.

Though, facilitators who are not as familiar with ballroom dance may need to take the time to review the style, so they can facilitate the sessions with confidence. The more the facilitator views the video and practices the movements prior to leading the session, the more effective the program will be. By the same token, participants may also have this challenge since not everyone likes to dance, be the center of attention, or like to be seen by an entire group, especially if they feel uncomfortable or think they are not a good dancer. Again, this is why it may be a good idea to use the same M3 lesson over a period of a few sessions. This way, the participants can gain confidence in certain styles of movement. It will also be important that the facilitator creates a session with an environment that supports all movement, and celebrates effort and creative expression rather than correct execution of movement.

Cross-Cultural Considerations

In order to effectively run the program, it is important to strive to understand any cultural differences among the participants as well as the staff members. The population the program is geared toward is older adults with dementia. However, even with older adults, there can be noticeable age differences. Someone in their sixties may vary largely from someone in their eighties. With that being said, the provider must be cognizant of the generational differences, especially when considering music choices and when referring to a specific participant about a time in history. Thus, with M3 it is important to allow the participants to reminisce; to share their backgrounds, experiences, and self. One may find that the differences in backgrounds will actually enrich the M3 sessions.

54 Varied ethnic backgrounds is another important topic for consideration. People of different ethnic backgrounds may gravitate towards the dances differently. The dances in this program have different cultural backgrounds as well; such as the differences between the waltz and the rumba. The waltz may yield higher interest in one type of background, while the rumba may yield higher interest in another type of background. This may also go hand-in-hand with being aware of socioeconomic status as certain dances may have been more available or popular for certain populations. The dances themselves were either created by groups of people in poverty or by groups in upper classes of society. Keeping this in mind, facilitators may choose to start with an M3 lesson that their population would most enjoy, rather than starting at Lesson 1 and working their way through the curriculum systematically. Is it important to note that M3 is a flexible curriculum when the facilitator is considering the sequence of lessons. Facilitators can choose to arrange the lessons in the order they see fit for their population.

Because ballroom dance was traditionally done with one male partner and one female partner, dancing with someone of the same gender may be something to take into consideration.

For example, a male participant may not be so receptive to or comfortable with dancing with a male facilitator. It is important to acknowledge the program is different from traditional ballroom dancing. It is not a ballroom dance class; however, it is DMT-influenced program. Of course, the facilitator should offer to dance with any participant, and if the individual is not open to it, then the facilitator has to validate their choice and redirect to another participant or intervention.

Cognitive differences and the ability to communicate will be different with each person.

It is key to pick up on these differences in order to effectively communicate with each person.

Facilitators will need to determine whether verbal or nonverbal language will be used more effectively. Aphasia is a common dementia symptom and knowing how to effectively

55 communicate with someone who has severe aphasia will determine how effective the program will be for that individual.

Finally, ambulation and mobility will be different among each participant. There may be some participants who can ambulate and move without assistance; however, there are those who need special assistance. As ballroom dance is traditionally done standing up on both feet, there may be a challenge when participants are not aware of each other’s capabilities and may ask each other to dance. It is important that the facilitator invites all movements as long as it is safe for them and others. Again, in these cases, facilitators need to encourage the individual’s movements and praise all effort rather than the execution of movement.

Ethical Considerations

To protect the safety of each collaborator, first and foremost, collaborator information was protected. Confidentiality was highly practiced. First, collaborators were asked to sign an informal collaborator agreement, which framed the project’s expectations and goals, and provided the option to remain anonymous. Regardless of whether collaborators chose to remain anonymous, information was recorded and stored on this writer’s personal MacBook, which was safeguarded using password protection and remained either with the writer or in his private home at all times.

It was important to recognize power dynamics; however, this type of case would be unlikely to affect the process due to the individualized discrete nature of the information gathering process. That said, the interactive nature of the interviews and questionnaires moderated the possibility of power imbalances between collaborators and this writer.

56 Dance/Movement Therapy vs. DMT-Influenced Program

There is a huge difference between the program facilitated by a dance/movement therapist, versus being facilitated by a care provider who is not a dance/movement therapist. A dance/movement therapist can utilize the program to facilitate DMT; however, a non-DMT care provider facilitating the program is providing therapeutic dance, hence, M3 designed as a DMT- influenced program. If a dance/movement therapist facilitates the program, they will use the

DMT theories, methodologies and techniques to use movement and the body to address the situation psychologically. They can utilize Section VI of the lessons in M3 as DMT interventions to the fullest of their knowledge and education in the field. Other care providers, which may or may not have counseling/psychotherapy skills can facilitate the program. However, without having the knowledge of DMT practices, or movement observation and analysis skills, they are unequipped to provide DMT. In this case, the non-DMT care provider will be facilitating therapeutic dance.

Dance/movement therapy versus a DMT-influenced program can better be understood when differentiating between dance/movement therapists facilitating DMT and a dance artist facilitating therapeutic dance. In the conference lecture The Difference Between ‘Therapeutic’

Dance and Dance/Movement Therapy by Susan Imus (2014), she explains, “[Dance/movement therapists] use dance and movement to foster health, communication, and expression; promote the integration of physical, emotional, cognitive, and social functioning, enhance self-awareness, and facilitate change,” whereas, dance artists take a different approach through art, education, and recreation (see Appendix I).

Facilitating this program as DMT requires the ability to bring the participants into a space of therapy, using the tools and knowledge in DMT and taking what is being observed and

57 experienced and turning it into a process in which to learn and go beyond dance at face-value.

This is the process to provide a deeper emotional, cognitive and overall therapy experience.

When facilitated by a non-DMT care provider, the program is then considered to be

DMT-influenced. The facilitator will still have the ability to facilitate the program and provide a safe and open environment for the participants, while supporting reminiscence, creative expression and socialization; and the DMT aspect is the structure and format that is the foundation of M3. The facilitator will be utilizing M3 as a DMT-influenced dance program.

Future Plans and Evaluation Suggestions

Facilitators would have the written curriculum, supplementary video and PowerPoint presentation slides. With these materials, care providers will have adequate tools to facilitate the program. All of these materials would come together and be available for care providers to utilize. All the clinician would need is the appropriate place and setting to facilitate the program.

Further research and expansion of this project may warrant further development with professional organizations to expand on the current body of research, and to aid in the validity of the program. Organizations include: The Alzheimer’s Association, Department of Family and

Child Services, American Dance Therapy Association, American Psychological Association and

American Counseling Association. These governing bodies may provide evaluating tools and opportunities to cultivate this program into something highly effective across different counseling practices.

Evaluation models and tools can be used to assess the outcomes of the program. These outcomes can range from changes in participants’ behavior and level of functioning to changes in knowledge and skills. Because cognitive function is impaired with people with dementia, further exploration is needed for someone to gather and evaluate data of the program. Evaluation can be

58 a challenge when data collection of individuals with dementia is difficult to obtain due to cognitive and physical impairment. However, there are ways this can be done such as a way to observe and assess participants’ behavior in the moment. One of the tools that can be used is a mood scale (Albert King, 2018). According to the conference presentation by Audrey Albert

King (2018), she used a mood scale, similar to a Likert scale, which measured how an individual felt. The scale ranged from zero to ten or upset/sad/worried/angry to happy/relaxed (see

Appendix J). In Albert Kings’ work with people with dementia (2018), she had participants point at where they felt they were on the mood scale once before and once after the session. Further research can implement the M3 curriculum and utilize this type of measurement tool to determine the effectiveness of M3 on persons with dementia.

Questions that still need to be addressed are: How can this program be utilized in other settings? How can this program be utilized with other populations? What other ballroom dance styles can be used in the format of this program? How can this program be specifically beneficial to other etiologies of dementia, such as Lewy body disease, Parkinson’s disease, frontal temporal lobe disease, traumatic brain injury, etc.? What other DMT interventions can be used to support creative expression, reminiscence and socialization? What other important goals and objectives can be addressed with this program?

Moving forward, M3 can be expanded to be utilized with other populations such as those of different age groups and other mental illnesses. With more research and future implementation, this program—seated or standing—can be effective work with children, couples, families, LGBTQI+, and individuals challenged with mood disorders, body dysmorphic and sex disorders, and other cognitive disorders. Ballroom dancing provides a relationship and

59 socialization aspect, as described in Chapter Two. Because the aforementioned populations involve some social aspect and a relationship to the self and other, M3 may benefit them as well.

Conclusion

This program development project was created to provide a safe and unique dance program for persons with dementia, a disorder that needs proper programming and further support. It was created to understand and explore how ballroom dancing can be used as DMT in a DMT-influenced program for dance/movement therapists and non-DMT care providers. This program aims to address the importance of supporting creative expression, socialization and reminiscence. M3 was developed using the theory approach logic model with collaborator help via the Delphi method. Although the logic model was utilized, impact of the program was not addressed as possible evaluation of the program must be completed and analyzed with a projected timeline of seven to ten years (W.K. Kellogg Foundation, 1998).

There is a great deal more to investigate to further this program in many dimensions. This program has the potential to help the fields of DMT and counseling in many aspects. However, implementation is only possible if it is up to par with safety, ethical and cultural considerations.

With person-centered care being part of the foundation of this program, it is important to acknowledge each participant’s cultural backgrounds individually and collectively as a group.

These cultural considerations can support a more cohesive group session and will help the therapeutic relationship.

Ballroom dancing has been proven to be a very powerful experience for many. Another aim of M3 was to share that love and passion for the art of ballroom in a therapeutic context. The use of ballroom dance in an adult day program for persons with dementia can support creative expression, reminiscence and socialization. M3 can tend to the needs of the participants, which in

60 turn, provide fun and therapy to each individual and keep them engaged. The program can support quality of life in this population, and the impact it would have if it were to continue and to develop in other organizations and agencies could be significant. Using Chacian theory and techniques combined with Laban Movement Analysis, the program has the potential to be an effective means of ballroom dance therapy. With the use of the supplementary materials, a care provider can lead a therapeutic dance session, which could also yield various positive results.

Future programming involves different professional fields and backgrounds; however, it is important to acknowledge the responsibilities each care provider has to effectively facilitate

M3 and all of its parameters. When facilitated by a dance/movement therapist, he or she has the tools and knowledge to facilitate this program as DMT. As a non-DMT care provider, the program is still influenced by DMT, but should be implemented as a therapeutic dance program.

In the future, the M3 curriculum can be expanded upon, be professionally evaluated and implemented among different populations and settings.

Personally, creating this program has helped me understand myself on a deeper level; deepening the body, mind and spirit connection. This project helped me do what I have always wanted to do—to combine my love and knowledge of ballroom dance with my passion for helping others, especially in this older adult community. Not only do I continue to grow as a professional in the field, I hope this program development will continue to grow the field of dance/movement therapy.

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67 Appendix A

Definition of Key Terms

Ballroom dance. An umbrella definition of many styles of partner dance such as waltz, tango, foxtrot, cha cha, rumba, swing, etc. Each dance style has specific, structured movement patterns. Ballroom dance can be done both competitively and in a social setting. This thesis will use ballroom dance in the context of a social dance, which is about creativity and expression, without the expectations of proper technique (Powers, 2014, para 5). One’s experience in ballroom dance can be deeply personal and can elicit reminiscence of a time when the individual danced with someone else. Ballroom dance may provide outlets to express emotions through movement in a social environment.

Creative expression through movement. This term, which can also be interchangeable with nonverbal creative expression, is the “mind-body connection, the creativity and expression of dance and the arts, and the ability of movement to help us connect to ourselves, one another, and our environment” (Coote, 2017, para 5).

Dance/movement therapy-influenced dance program or DMT-influenced. “Dance programs incorporate elements of expression, relaxation, interaction and body-awareness,”

(Ritter & Graff, 1996, p. 249). This DMT-influenced dance program addresses “psychosocial experiences and expressing feelings and emotions…evoked with the use of the DMT as the activity involves group sessions allowing participants an opportunity to communicate and share their emotions with others,” (Palo-Bengston & Ekman, 2002, p. 143). This dance program is

DMT-influenced because it can be utilized to provide DMT if a dance/movement therapist uses their skills and knowledge to facilitate DMT interventions through ballroom dance movements.

However, this dance program, if facilitated by a non-DMT care provider, can still facilitate with

68 the aid of PowerPoints, videos, and other supplementary material, in order to still provide an environment that addresses similar goals.

Dementia. This term is not a specific disease, but rather a term that describes a broad range of symptoms related to the decline in memory and other thinking skills severe enough to reduce a person’s capacity to perform daily activities. Alzheimer’s disease accounts for sixty to eighty percent of cases of dementia. Dementia, more formally referred to as a neurocognitive disorder, requires at least two of the following cognitive impairments: “memory, communication and language, ability to focus and pay attention, reasoning and judgement, [and] visual perception” (Alzheimer’s Association, 2018a, para 5).

Person-centered dementia care. This type of care is the foundation of the therapeutic framework at adult day programs for persons with dementia. Developed by Dr. Thomas

Kitwood, the person comes first, people with dementia are just people first and foremost. These individuals have the same needs, wants, and desires, and so these clinical settings utilize this framework in order to meet their participants to see that their needs, wants, and desires can be met as much as possible. This form of care views all behaviors as attempts to communicate, as

“all behavior has meaning—all action is meaningful,” (North Shore Senior Center, 2014, p. 8).

Quality of life. The term quality of life is subjective and deeply personal for each individual. It may include different factors such as: the ability to think, make decisions, and have control in one’s everyday life, one’s physical and mental health, social relationships, religious beliefs/spirituality, cultural values/norms, and a sense of community (Alzheimer’s Association,

2018a). Quality of life can be observed in a day program setting from the verbal and nonverbal interactions that participants have with staff, volunteers, and other participants, engagement and participation in activities, and their overall happiness/enjoyment as evidenced by facial

69 expressions, laughter, and verbal/nonverbal feedback. This program development project addressed creative expression, reminiscence, and socialization (see definitions of these terms in this section) which are significant components that are related to quality of life with older adults with dementia.

Reminiscence. This refers to the “sharing of life experiences, memories, and stories from the past” (Social Care Institute for Excellence, 2015, para 1). People with dementia are better capable of recalling earlier memories than the more short-term recent memories, and therefore reminiscence can hone in on this strength of peoples with dementia (Social Care Institute for

Excellence, 2015).

Seated format. Providing therapy while sitting in chairs is important to dementia care safety practices. Participants may be in their final stages of dementia and have the inability to walk without assistance, have impairments in sensory functioning such as positioning of limbs and joints, tactile senses, and balance, coordination, strength, and endurance (Alzheimer’s

Association, 2018a). A seated format is vital to the safety concerns of the population and will be used throughout a session, with the exception that if an individual wants to stand up and dance, a staff member will accommodate by dancing with or supporting the individual with balance and mobility.

Socialization. According to the Alzheimer’s Association (2018a), socialization enhances the lives of people with dementia, including their care partners. Being social and in a social environment is essential to a healthy brain along with movement/exercise.

70 Appendix B

Chace and Kitwood Integration Model (Erenberg, 2007)

71 Appendix C

Collaborator Agreement

I, ______, agree to collaborate with J.R. “Zano” Manzano on his program development project.

The purpose of this thesis is to develop a dance/movement therapy-influenced dance program for an adult day program for persons with dementia, which will provide a seated format of ballroom dance for older adults with dementia. This program development aims to support the quality of life of peoples with dementia, and therefore addresses the following question: How can seated ballroom dancing in a dance/movement therapy-influenced dance program be utilized in order to support the following factors of quality of life— creative expression, enjoyment, reminiscence, and socialization—of older adults with dementia at an adult day program? The following is an additional question that might be addressed after information gathering: How can this program be used in other dementia-related clinical settings?

I agree that Zano retains the right of the intellectual property that is the concluding program and that all of my contributions will be used for the benefit of the developed program. I agree that my purpose as a collaborator is to contribute to a consensus around the proposed topic. I agree that my involvement is for the purpose of Zano’s graduation requirements and that I will not be compensated for my participation. I am in no way solely responsible for this project and understand that Zano is the leader of this project development. I understand that my involvement in this project will consist of participating in a questionnaire, followed by one informal interview lasting up to thirty minutes, and one final questionnaire. I understand that communication may be done via email if further information is needed of me. I understand that I have the option of remaining anonymous if I so choose, and that I have the option of rescinding my involvement in this project at any time.

I agree that Zano has the following obligations to me:

• Zano will be on time for our scheduled interviews unless uncontrollable circumstances occur, to which he will notify me immediately. • Zano will comply with my decision to rescind my involvement at any time if I choose to do so. • Zano agrees to invite any and all feedback from me anytime throughout the process of the project development. • Zano will honor my choice of confidentiality in using my name in the program development project

______I give my permission to use my name in the program development project. ______I DO NOT give my permission to use my name in the program development project.

Signature______Date______

72 Appendix D

Logic Model (W.K. Kellogg Foundation, 2004)

73 Appendix E

Round 1 Questionnaire

1. Based on quality of life, I have identified the following to incorporate as program

goals/objectives: socialization, reminiscence, recreation, emotion, and creative

expression.

a. What others might be present?

b. What seems to be the most important to address?

2. Would specific dyad work or group experiential learning, or both, be beneficial?

a. Would dyad work be present in a group session?

b. If not, what are other ways participants may utilize this program in a dyadic

partnership?

3. How do you see this program as supplementing or distracting from the work that you

do?

4. What cultural factors need to be considered in the following areas:

a. [Day program]?

b. [The organization]?

5. What resources are necessary for the program?

a. What space could be used?

b. What staff presence would be necessary?

c. What time of day would work best?

d. How long/how many sessions should the program be?

e. What is a feasible session length?

f. Should sessions build on each other consecutively or be stand alone?

74 g. What is the ideal minimum/maximum number of participants?

h. Would the organization contribute to the program resources?

6. What safety concerns might need to be considered for a program like this?

7. What external factors might affect the planned work and/or program results?

8. What obstacles might be present in implementing a program like this?

9. How effective can this program be facilitated:

a. As therapeutic by those who are not dance/movement therapists?

b. As therapeutic by those who are not creative arts therapists/clinicians?

c. As a therapist/clinician to provide therapy/ dance/movement therapy?

10. Do you have any other thoughts or questions for me?

75 Appendix F

Round 3 Questionnaire

1. Based on quality of life, I have identified the following to incorporate as program

goals/objectives: socialization, reminiscence, and creative expression.

a. Are the movements, paired with the music in the video, representative of these

goals/objectives? Why or why not?

2. Can dyadic work or group experiential learning be beneficial using these movements?

3. Are cultural factors considered in the movements, music, etc. in the video? Why or

why not?

4. With the proper resources (chairs, refreshments, private space, etc.), can this activity

be effectively facilitated?

5. What safety concerns are or are not attended to in the video?

6. How effective can this program be facilitated (may think in terms of interventions):

a. By a dance/movement therapist?

b. By a non-DMT care provider?

7. How can this video and/or the contents in the video be improved?

8. Do you have any other thoughts or questions for me?

76 Appendix G Video Agreement

I, ______, agree to collaborate with J.R. “Zano” Manzano on his program development project.

The purpose of this thesis is to develop a dance/movement therapy-influenced dance program for an adult day program for persons with dementia, which will provide a seated format of ballroom dance for older adults with dementia. This program development aims to support the quality of life of peoples with dementia, and therefore addresses the following question: How can seated ballroom dancing in a dance/movement therapy-influenced dance program be utilized in order to support the following factors of quality of life—creative expression, enjoyment, reminiscence, and socialization—of older adults with dementia at an adult day program? The following is an additional question that might be addressed after information gathering: How can this program be used in other dementia-related clinical settings?

I agree that Zano retains the right of the intellectual property that is the concluding program and that all of my contributions will be used for the benefit of the developed program. I agree that my involvement is for the purpose of Zano’s graduation requirements and that I will not be compensated for my participation. I am in no way solely responsible for this project and understand that Zano is the leader of this project development. I understand that my involvement in this project will consist of participating in a video that will supplement Zano’s thesis project. I understand that communication may be done via email or mobile phone if further information is needed of me. I understand that I have the option of rescinding my involvement in this project at any time.

I agree that Zano has the following obligations to me:

• Zano will be on time for our scheduled meetings unless uncontrollable circumstances occur, to which he will notify me immediately.

• Zano will comply with my decision to rescind my involvement at any time if I choose to do so.

• Zano agrees to invite any and all feedback from me anytime throughout the process of the project development.

• Zano will honor my choice of confidentiality in using my name in the program development project.

______I give my permission to use my name in the program development project. ______I DO NOT give my permission to use my name in the program development project.

Signature______Date______

77 Appendix H

PowerPoint Presentations

Lesson 1: Waltz.

https://www.youtube.com/watch?v=2Y6SfCJBSJI

Lesson 2a: Cha Cha.

https://www.youtube.com/watch?v=eGSA53_qRys

Lesson 2b: Rumba.

https://www.youtube.com/watch?v=ZqMSJzWZLCY

Lesson 3: Tango.

https://www.youtube.com/watch?v=QvdjrE6IzN4

Lesson 4a: Foxtrot.

https://www.youtube.com/watch?v=STwXcoG2o6Q

Lesson 4b: Swing.

https://www.youtube.com/watch?v=7MluIP-iDVc

78 Appendix I

Dance/Movement Therapy vs. Therapeutic Dance Model (Imus, 2014)

79 Appendix J

Mood Scale (McKenna, Gallagher, Forbes, Ibeziako, 2015)

80 Manzano Movement Method (M3) Video https://www.youtube.com/watch?v=7hbbbqkSKro